Meaningful outcome research to validate endoscopic treatment of common lumbar pain generators with durability analysis

摘要

Endoscopic spine surgery may be questioned for its medical necessity and effectiveness when compared to other forms of spinal surgeries. The call for clinical evidence to justify the need for capital equipment purchases, disposables, and additional training often follows and is echoed by the repetitive question why endoscopy is better and more cost effective than traditional open or other types of translaminar minimally invasive spine surgery. What is evident though, is the pushback by payers purely against any advancement in spine care because of escalating costs. Lack of clinical evidence is the number one cited reason why coverage for proposed endoscopic spine care is denied by deeming it experimental and medically not necessary. Clinical coverage- and treatment guidelines written by payers and surgical societies are centered around available high-grade evidence published in the peer-reviewed literature. Most outcomes studies in endoscopic spine surgery are level III retrospective case series published by pioneers of the procedure including the senior author of this editorial—Anthony Yeung, MD ( ). Level I, and II prospective randomized trials are few far and between. However, a few high-grade studies comparing outcomes with endoscopic- versus microsurgical decompression have been published.