Abstract / Summary
The aim of this study was to compare the incidence of wound dehiscence between biportal endoscopic spine surgery (BESS) and microscopic spine surgery (MSS) for single-level lumbar decompression or discectomy and identify the risk factors associated with this complication.
Data from 2 randomized controlled trials comparing BESS and MSS for lumbar spinal stenosis and disc herniation were pooled for analysis. The primary outcome was wound dehiscence, defined as wound separation requiring resuturing after suture removal. Risk factors were analyzed using risk ratios with 95% confidence intervals. A subgroup analysis was performed within the MSS group to identify additional risk factors.
A total of 211 patients were analyzed (BESS, n = 108; MSS, n = 103). Wound dehiscence occurred in 9 patients (4.3%), all of whom were in the MSS group (0.0% vs 8.7%; OR 0.046, 95% CI 0.003-0.798; p = 0.001). In the entire cohort, incision length ≥ 35 mm showed the highest risk ratio (RR) (15.44) for wound dehiscence (p = 0.001). Other significant risk factors included drainage ≥ 100 mL (RR 8.55) and changes in white blood cell count ≥ 2 × 103/µL (RR 7.78). Within the MSS subgroup, drainage ≥ 100 mL was the only statistically significant risk factor (RR 9.17, p = 0.011).
BESS was associated with significantly lower wound dehiscence rates compared with MSS in patients undergoing single-level lumbar decompression or discectomy. Drainage volume ≥ 100 mL may serve as a clinical indicator for enhanced wound surveillance in MSS patients. These hypothesis-generating findings warrant validation in independent cohorts.