Endoscopic spine is emerging in the U.S. with many spine surgeons and patients embracing the technology. However, the nation trails the rest of the world in widespread adoption.
The reason for this includes different strategies in international payer systems, prior authorizations and coding, Kai-Uwe Lewandrowski, MD, told Becker’s.
Dr. Lewandrowski, who’s on the board of the International Society for the Advancement of Spine Surgery-Asia Pacific, spoke with Becker’s about lessons the U.S. can take from global peers in endoscopic spine adoption.
Note: This conversation was lightly edited for clarity.
Q: Global regions such as Asia-Pacific and India are taking a “full force” approach with endoscopic spine adoption. What’s working for them, and what are the biggest regulatory obstacles they’ve overcome?
Dr. Kai-Uwe Lewandrowski: China and many other Asian countries essentially skipped over the microscope era. For years, open surgery remained the standard, while microsurgical techniques were gaining traction in Europe and the U.S. When endoscopy emerged, these regions adopted it directly as their next logical innovation. Microsurgical dissection never became as deeply rooted in their surgical culture, so endoscopy filled that space naturally. That’s the historical backdrop.
Their healthcare systems also make implementation easier. China, for example, operates under a large government-driven, single-payer system. Singapore follows a similar model—primarily single-payer, with the option of supplemental private insurance. Most patients are treated within the public system, which has introduced regulations that effectively streamline adoption. By reducing equipment costs and simplifying approval pathways, they’ve made it far easier for hospitals and surgeons to transition to endoscopy.
A physician recently told me that, unlike in the U.S., they don’t deal with the same front-end insurance authorization burden. Instead, they undergo annual audits conducted by government-appointed spine surgeons who review hospital charts to assess whether care was appropriate and timely. It’s oversight, but not obstruction. That structural simplicity — combined with lower equipment costs and predictable reimbursement — has fueled widespread adoption.
Another key factor is how surgeons are compensated. In Asia, endoscopic spine surgery is explicitly recognized and reimbursed as a surgical procedure. That distinction matters. In the U.S., if we fail to update coding and retire outdated descriptors like CPT 62380, the procedure risks being marginalized—abandoned by surgeons and absorbed by non-surgical providers. Asia’s clarity on this point has been crucial to its success.
Q: Do you see a clear path to growing endoscopic spine access in the U.S.?
Dr. Lewandrowski: We recently conducted a study that I presented at ISASS–Asia Pacific (ISASS-AP) titled “Orphaned Innovation.” The findings revealed that the primary barriers to endoscopic spine adoption in the United States are not patient demand or surgeon disinterest, but rather institutional and cultural constraints. Chief among these are high procedural costs and inconsistent, often inadequate, reimbursement.
The path forward lies in learning from international models — lowering procedural barriers, streamlining approvals, and formally recognizing endoscopic spine surgery as a mainstream surgical discipline performed by surgeons. The learning curve is steep: many seasoned spine surgeons describe mastering endoscopy as more challenging than learning a standard open decompression, and in some ways even more technically demanding than a basic fusion. That degree of skill and responsibility deserves appropriate recognition within our reimbursement framework.
If we fail to classify and support it as surgical, endoscopic spine care risks being relegated to the margins—performed by non-surgical providers at a lower standard and detached from the technology’s full potential. Real progress begins with policy and reimbursement reform.
