J Neurol Surg A Cent Eur Neurosurg 2024; 85(02): 182-191
DOI: 10.1055/a-2029-2694
Review Article

Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review

Kashyap Patel
1   Baroda Medical College, India, Vadodara, Gujarat, India
2   Society for Brain Mapping & Therapeutics (SBMT), Los Angeles, California, United States
Mandara Muralidhar Harikar
3   Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
Tejas Venkataram
2   Society for Brain Mapping & Therapeutics (SBMT), Los Angeles, California, United States
3   Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
4   Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, San Francisco, California, United States
5   Department of Medicine, Multispeciality, Trauma and ICCU Center, Sardar Hospital, Ahmedabad, Gujarat, India
6   Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
Marjan Assefi
7   University of North Carolina at Greensboro, Greensboro, North Carolina, United States
Namath Hussain
8   Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States
Vicky Yamamoto
9   University of Southern California Keck School of Medicine, The University of Southern California Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California, United States
10   University of Southern California-Norris Comprehensive Cancer Center, Los Angeles, California, United States
11   Brain Mapping Foundation (BMF), Los Angeles, California, United States
Babak Kateb
11   Brain Mapping Foundation (BMF), Los Angeles, California, United States
12   Brain Technology and Innovation Park, Los Angeles, California, United States
Kai-Uwe Lewandrowski
13   Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona, United States
3   Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
› Author Affiliations


Background Minimally invasive spinal surgery (ESS) are both well-established surgical techniques for lumbar spinal stenosis; however, there is limited literature comparing the efficacy of the two techniques with respect to radiologic decompression data.

Methods In this review, PubMed, Google Scholar, and Scopus databases were systematically searched from inception until July 2022 for studies that reported the radiologic outcomes of endoscopic and minimally invasive approaches for decompressive spinal surgery, namely, the spinal canal area, neural foraminal area, and neural foraminal heights.

Results Of the 378 articles initially retrieved using MeSH and keyword search, 9 studies reporting preoperative and postoperative spinal areas and foraminal areas and heights were finally included in our review. Of the total 581 patients, 391 (67.30%) underwent MISS and 190 (32.70%) underwent ESS. The weighted mean difference between the spinal canal diameter in pre- and postoperative conditions was 56.64 ± 7.11 and 79.52 ± 21.31 mm2 in the MISS and ESS groups, respectively. ESS was also associated with a higher mean difference in the foraminal area postoperatively (72 ± 1 vs. 35.81 ± 11.3 mm2 in the MISS and ESS groups, respectively), but it was comparable to MISS in terms of the foraminal height (0.32 ± 0.037 vs. 0.29 ± 0.03 cm in the MISS and endoscopic groups, respectively).

Conclusions Compared with MISS, ESS was associated with improved radiologic parameters, including spinal canal area and neural foraminal area in the lumbar spinal segments. Both techniques led to the same endpoint of neural decompression when starting with a more severe compression. However, the present data do not allow the correlation of the radiographic results with the related clinical outcomes.

Supplementary Material

Publication History

Received: 20 September 2022

Accepted: 02 February 2023

Accepted Manuscript online:
06 February 2023

Article published online:
02 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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