Wound dehiscence following biportal endoscopic versus microscopic spine surgery for single-level lumbar decompression: a post hoc analysis of two randomized controlled trials
In brief
Biportal spine surgery had no wound separation, versus 9% with microscopic surgery
In a post hoc analysis of two trials involving 211 patients, wound separation requiring resuturing occurred in none of those having biportal surgery and in 9 of 103 patients having microscopic surgery. Higher wound drainage was linked to greater risk in the microscopic group, but these findings need confirmation before they guide care.
- Journal
- Neurosurgical focus (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sang-Min Park, Kwang-Sup Song, Ho-Joong Kim, Min-Seok Kang, Ki-Han You, Jin-Sung Kim, et al.
- PMID
- 42822040
- DOI
- 10.3171/2026.7.FOCUS26203
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 4 October 2026): Post‑hoc analysis of RCTs, wound dehiscence after spine surgery
- Picked for Spine Surgery (top studies of the week, 4 October 2026): Wound dehiscence, BESS vs MSS, lumbar decompression
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.