Endoscopic spine surgery has been growing steadily in the U.S., but a barrier to surgeon adoption is its learning curve. A systematic review published in the March 2026 issue of The Spine Journal examined the learning curves for uniportal and biportal endoscopic spine techniques and found some differences between the two.
Six things to know:
1. The systematic review included 29 studies — 18 of them focused on uniportal learning curves and 11 on biportal.
2. A total uniportal 1,493 endoscopic spine patients and 1,005 biportal patients were included.
3. The median number of cases to reach the learning curve threshold was was significantly less in uniportal studies compared to biportal. For uniportal cases the median learning curve was 20 cases and 37.5 for biportal.
4. When stratified for different procedures, there was no significant difference between the techniques with number of cases required.
5. Operative time for biportal discectomies decreased by a significantly greater amount compared to uniportal endoscopic discectomies.
6. The study concluded, “The learning curve literature for ESS was systematically reviewed and ways to overcome the learning curve were discussed. The overall median number of cases for the learning curve was significantly fewer in uniportal vs biportal but the improvement in operative time was significantly greater with biportal discectomies, typically the entry level procedure by novice surgeons. Overcoming the learning curve for ESS is a critical factor to widespread adoption and understanding it may aid surgeons in progressing to proficiency while mitigating the risk of complications.”
