One of the main causes of chronic pain and disability globally, degenerative spinal illnesses also constitute a substantial healthcare burden. When conservative treatment fails, conditions include degenerative spondylosis, lumbar disc herniation, and spinal stenosis often call for surgery. For many years, traditional open spine surgery has been the gold standard for both neural decompression and symptom alleviation. On the other hand, substantial muscle dissection, higher blood loss, postoperative pain, and extended recovery times are frequently associated with open surgeries.

Spinal surgery has changed as a result of the development of minimally invasive surgical methods. By using specialized cameras and devices inserted through tiny incisions, endoscopic spine surgery minimizes soft tissue disruption while enabling direct view of neural systems. Reduced surgical discomfort, shorter hospital stays, less blood loss, fewer infections, and an earlier return to regular activities are some potential benefits.

Despite these advantages, questions about the learning curve for endoscopic procedures, the effectiveness of decompression, and long-term results still need to be answered. While some studies imply that minimally invasive techniques offer better early recovery, others report comparable clinical and radiological outcomes between endoscopic and traditional treatments.

Validated tools like the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) are frequently used to evaluate functional outcomes after spine surgery. Adequate decompression, preservation of spinal alignment, and identification of postoperative problems are the key objectives of radiological examination.

Comparative studies assessing the efficacy of endoscopic spine surgery in comparison to traditional open surgery are crucial as its use grows. Surgeons can maximize patient selection and enhance treatment plans by comprehending variations in outcomes.

Between January 2025 and January 2026, the Department of Orthopedic Surgery at Mayo Hospital Lahore carried out a prospective comparative study. There were 120 patients in all who had been diagnosed with lumbar spinal stenosis or lumbar disc herniation and needed surgery. Two groups of patients were created Endoscopic spine surgery (n = 60) is Group A Group B Open Spine Surgery Conventional (n = 60) Patients with severe deformities, injuries, infections, spinal tumors, or prior lumbar surgery were not included Demographic information, clinical examination, MRI results, Visual Analog Scale (VAS) pain score, and Oswestry Disability Index (ODI) were all part of the preoperative evaluation. Blood loss, the length of the procedure, and hospital stay were among the operative characteristics that were noted following surgery, patients were monitored for one, six, and twelve months. VAS and ODI ratings were used to evaluate functional results. Radiographs evaluating spinal alignment and postoperative MRI assessment of decompression adequacy were included of the radiological examination SPSS version 26 was used to analyze the data. The Chi-square test was used to assess categorical variables, while the Student's t-test was used to evaluate continuous variables. At p < 0.05, statistical significance was taken into consideration.

A total of 160 patients undergoing lumbar spine surgery were included in the study. Patients were divided into two groups: Endoscopic Spine Surgery (ESS) group (n=80) and Conventional Open Spine Surgery (CSS) group (n=80). The mean age of participants was 52.6 ± 11.4 years, with comparable baseline characteristics between both groups. The most common indications for surgery were lumbar disc herniation and lumbar spinal stenosis.

Patients undergoing endoscopic spine surgery demonstrated significantly lower postoperative pain scores, reduced intraoperative blood loss, shorter hospital stay, and faster return to daily activities compared with conventional surgery. Functional outcomes measured by the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) showed significant improvement in both groups, with greater early improvement observed in the endoscopic group. Radiological assessment revealed comparable rates of adequate decompression and postoperative spinal stability between both surgical techniques.

Table 1: Baseline Demographic and Clinical Characteristics of Study Participants

Table 2: Operative and Early Postoperative Outcomes

Table 3: Functional Outcomes (VAS and ODI Scores)

Table 4: Radiological Outcomes After Surgery

Table 5: Postoperative Complications

Table 6: Predictors of Better Functional Recovery (Multivariate Analysis)

The present study compared endoscopic spine surgery with conventional open spine surgery and demonstrated that both the techniques yielded satisfactory functional and radiological outcomes but with superior short-term recovery benefits for endoscopic surgery. Compared with conventional surgery, endoscopic procedures resulted in significantly less postoperative pain, less blood loss, shorter hospital stays, and earlier return to daily activities in patients. The lesser postoperative pain in endoscopic group can be attributed to lesser muscle dissection, preservation of paraspinal structures and minimal disturbance of normal spinal anatomy. Conventional open spine surgery usually needs wider exposure, which may cause greater soft tissue injury, postoperative inflammation and delayed rehabilitation. The minimally invasive nature of endoscopic techniques allows targeted decompression while preserving surrounding tissues. Functional assessment using VAS and ODI demonstrated significant improvement in both groups; however, the magnitude of improvement was greater among patients treated with endoscopic surgery. These findings support previous studies showing that minimally invasive spine procedures provide comparable neurological recovery with faster functional improvement. Reduced postoperative discomfort and earlier mobilization may contribute to improved patient satisfaction and quality of life. Radiological outcomes showed no significant difference between endoscopic and conventional surgery. Both approaches achieved adequate neural decompression, correction of pathology, and maintenance of spinal stability. This indicates that endoscopic surgery, despite smaller surgical exposure, can achieve similar anatomical results when performed in appropriately selected patients by experienced surgeons. The complication rate was significantly lower in the endoscopic group. Reduced wound complications may be explained by smaller incisions, limited tissue trauma, and decreased exposure of deep tissues. Although complications such as dural tears and neurological injury remain possible with both techniques, careful surgical planning and appropriate patient selection can minimize risks. The endoscopic approach was an independent predictor for better functional recovery. Other factors associated with improved outcomes included younger age, lower baseline disability, and absence of significant comorbidities. These findings underscore the importance of patient selection on an individual basis when considering minimally invasive spinal procedures. However, endoscopic spine surgery also has its limitations despite the benefits. It requires special equipment, high-level technical skills and a learning curve for the surgeons. However, complex spinal deformities, severe instability, extensive stenosis, and some revision cases may still require conventional approaches. Therefore, the surgical technique should be based on pathology, patient characteristics and surgeon expertise. Overall, the findings suggest that endoscopic spine surgery is an effective minimally invasive alternative to conventional spine surgery, offering comparable radiological success with improved early functional outcomes and reduced perioperative morbidity.

When compared to traditional open spine surgery, endoscopic spine surgery showed better short-term and intermediate-term functional results. Significantly less blood loss, shorter hospital stays, an earlier return to work, and improved postoperative pain and disability scores were all experienced by patients receiving endoscopic operations. The two methods had similar radiological results, such as adequate decompression and maintenance of spinal alignment. For certain individuals with lumbar degenerative spinal diseases, endoscopic spine surgery offers a safe and efficient minimally invasive option.

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