Demand and interest for endoscopic spine surgery is growing, and spine surgeons have discussed the elements that will push it to the next level.
1. A global adoption approach: Kai-Uwe Lewandrowski, MD, who’s on the board of the International Society for the Advancement of Spine Surgery-Asia Pacific, has a close perspective on how countries like China and Singapore have scaled endoscopic spine. The key differences compared to the U.S. include policy and reimbursement approaches.
“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,” Dr. Lewandrowski told Becker’s. “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.”
2. Navigational technology advancements: Ben Burch, MD, who has pioneered endoscopic spine in Mississippi and Georgia, said innovations in navigation will help unlock wider adoption among spine surgeons.
“I use the analogy a lot of building a ship in a bottle. That’s kind of what endoscopic spine surgery is,” Dr. Burch told Becker’s. “We’re still doing all of the work deep inside the body. We’re still doing the work at the level of the spine that you would do from a traditional surgery, but we’re doing it through very small openings. It’s like building a ship in a bottle to do that. You need to have a very good understanding of anatomy, and that requires use of things like intraoperative fluoroscopy and X-ray to triangulate and get the right angles and the right trajectories. As interoperative navigation technology advances, especially if you bring it to the ASC setting, a lot of surgeons will feel more comfortable adopting that technology and being able to see instead of just relying on 2D imaging. Navigation technology will help folks adopt this faster or easier in the future.”
3. Expanding applications: Xiaofei (Sophie) Zhou, MD, has explored some unique uses for endoscopic spine technique including an epidural abscess removal for a diabetic patient, she told Becker’s. By using an endoscope she was able to treat her patient without leaving a large surgical scar, and the patient was able to regain some function.
“The technology is limited right now by the kinds of tools that are at your disposal, and as we get more adept at entering the spine and this totally new view, we might be able to handle things that are a lot more complex,” Dr. Zhou said. “We might be able to handle things that include fusions. We have endoscopic transforaminal lumbar interbody fusions, but I think there are other avenues that we can explore. But I think it also begs the question of how many people actually need fusions if we can do a minimally disruptive surgery? There’s obviously a role for scoliosis surgery, large deformity corrections, and that’s certainly not something I think endoscopic spine is going to venture into in the next two, three years. But as we get more adept at seeing what the outcomes are pushing boundaries, we might be able to see new ways of utilizing endoscopic spine.”
