Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Background Lumbar spinal stenosis represents a prevalent degenerative condition that significantly affects patients' quality of life. Full-endoscopic decompression has emerged as a minimally invasive alternative to conventional techniques, although controversy persists regarding its efficacy and safety. Methods A systematic review was performed following PRISMA 2020 guidelines. Comprehensive searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant databases through October 2025. Comparative studies evaluating full-endoscopic decompression versus microscopic/open techniques in patients with symptomatic lumbar stenosis were included. Primary outcomes were pain improvement (Visual Analogue Scale, VAS), function (Oswestry Disability Index, ODI), and complications. Methodological quality was assessed using Cochrane and ROBINS-I tools. Results Nineteen studies including 1,997 patients and 2,132 spinal levels were identified. Endoscopic decompression was associated with significant reduction in intraoperative blood loss (weighted mean difference [WMD]= -33.29 mL, 95% CI: -51.80 to -14.78, p = 0.0032), shorter hospital stay (WMD= -1.79 days, 95% CI: -2.63 to -0.95, p = 0.001), lower incidence of incidental durotomy (RR = 0.63, 95% CI: 0.43–0.91, p = 0.0184) and surgical site infections (RR = 0.23, 95% CI: 0.10–0.51, p = 0.001). Full-endoscopic decompression demonstrated greater leg pain relief (MD= -0.20, 95% CI: -0.30 to -0.10, p = 0.001), reduced operative time (MD= -12.71, 95% CI: -18.27 to -7.15, p < 0.001), and lower complication incidence (RR = 0.43, 95% CI: 0.22–0.82, p = 0.01). VAS scores for back pain improved from 7.60 preoperatively to 1.80 at 6 months, while leg pain decreased from 7.20 to 1.76. ODI improved significantly from 76.35 to 10.34 at 6-month follow-up. According to modified MacNab criteria, 80-92.6% of patients achieved excellent or good results. Canal cross-sectional area increased significantly from 75.78 ± 28.45 mm² preoperatively to 155.2 ± 32.2 mm² postoperatively (p < 0.01). Conclusions Full-endoscopic decompression for lumbar spinal stenosis is a safe, effective, and minimally invasive surgical technique with substantial advantages over conventional methods. Endoscopic techniques demonstrate significant superiority in perioperative parameters with dramatically reduced bleeding, shorter hospital stay, and lower complication rates compared to microscopic decompression. Long-term functional clinical outcomes are comparable or superior. This modality constitutes a valuable alternative in the therapeutic armamentarium for lumbar spinal stenosis.