Objective: To analyse the incidence and gravity of reported complications that arise in spinal surgery and assess the comparative safety, or otherwise, of Endoscopic Laser Foraminoplasty.

Design: Prospective independently analysed study of complications arising during the six weeks following Endoscopic Laser Foraminoplasty was correlated and compared to a meta-analysis of reported data on complications in conventional spinal surgery.

Subjects: Nine hundred and fifty-eight procedures performed on 716 patients

Outcome measures: Occurrence of complications.

Results: The cohort integrity of operative and review records at six weeks after surgery was 100%. Twenty four complications occurred in 23 patients: nine cases of discitis (one infective) (0.9%), one dural tear (0.1%), one deep wound infection (0.1%), two patients suffered a foot drop (one transient) (0.2%), one myocardial infarction (0.1%), one erectile dysfunction (0.1%) and one post operative panic attacks (0.1%). MRI later demonstrated eight residual disc herniations (0.8%). The overall surgical complication rate was 1.6%. Meta-analysis of conventional spinal surgery reported overall complication rates for fusion (11.8%), decompression (7.6%), discectomy (6.0%) and chemonucleolysis (9.6%).

Conclusions: The complication rate of Endoscopic Laser Foraminoplasty is significantly lower than that reported following conventional spinal surgery (P < 0.01).