Multicenter Cohort Validation of Endoscopic Dual-Zone Decompression for Lumbar Spinal Stenosis: A Comprehensive Assessment of Perioperative Hidden Trauma and Hidden Blood Loss
Abstract
Abstract Background Traditional assessments of minimally invasive spine surgery (MISS) often rely on superficial metrics like incision length and overt blood loss (OBL), neglecting systemic stress and hidden blood loss (HBL). Objective To evaluate the perioperative hidden trauma, muscle injury, and HBL of endoscopic dual-zone decompression (DZD) compared with transforaminal lumbar interbody fusion (TLIF) in elderly patients with degenerative lumbar spinal stenosis (DLSS). Methods A retrospective, multicenter cohort study was conducted on 432 elderly patients with DLSS from January 2024 to December 2025. Patients were divided into the DZD group (n = 220) and the TLIF group (n = 212). Propensity matching verified homogeneous baselines across 12 variables (P > 0.10). Total blood loss (TBL) and HBL were derived utilizing the Nadler and Gross equations. Systemic inflammatory dynamics (Interleukin-6 [IL-6], Tumor Necrosis Factor-α [TNF-α]) and multifidus muscle damage (Creatine Kinase [CK]) were tracked longitudinally at preoperative (T0), postoperative 24h (T1), 72h (T2), and 7 days (T3). Results OBL was significantly lower in the DZD group than in the TLIF group (45.2 ± 12.4 mL vs. 412.8 ± 85.4 mL, P
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 432 participants or records.
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