Evolution of Endoscopic Spine Surgery: Contemporary Advances and Future Directions.

PURPOSE OF REVIEW: Endoscopic spine surgery has evolved from non-visualized percutaneous discectomy only, into a comprehensive minimally invasive surgical platform with expanding indications across cervical, thoracic, and lumbar pathology. This review examines endoscopic spine surgery's historical evolution, summarizes recent advances in technology and clinical application, and evaluates current evidence regarding outcomes, complications, and future directions. RECENT FINDINGS: Endoscopic spine surgery demonstrates clinical outcomes comparable to traditional open and minimally invasive approaches for lumbar disc herniation and spinal stenosis. Advantages of endoscopic approach include reduced tissue disruption, decreased blood loss, shorter hospitalization, expedited recovery, and faster return to work. Emerging applications include endoscopic-assisted fusion procedures, outpatient spine surgery pathways, and revision decompression techniques. Recent meta-analyses additionally suggest comparable outcomes between uniportal and biportal approaches, although differences in visualization, ergonomics, and learning curves remain areas of ongoing investigation. Current data supports the safety and efficacy of endoscopic surgery in appropriately selected patients, particularly for lumbar decompression procedures. Barriers including steep learning curves, limited formalized training pathways, equipment costs, reimbursement challenges, and the need for long-term comparative outcomes data continue to limit widespread adoption. Future integration of robotics, artificial intelligence, navigation technologies, and biologic augmentation may further expand the role of endoscopic spine surgery.