Current role and future perspectives of endoscopic spine surgery: a narrative review

Purpose: This review summarizes the evolution of endoscopic spine surgery (ESS), tracing its development from the initial treatment of lumbar disc herniation to its broader use in diverse spinal pathologies, including lumbar spinal stenosis, cervical foraminotomy, thoracic decompression, and lumbar interbody fusion. In addition, this review discusses the current body of evidence and examines future directions, particularly the integration of advanced technologies such as artificial intelligence (AI) and robotic assistance.Current Concepts: Over the past 2 decades, ESS has advanced considerably. Once used cautiously for lumbar disc herniation, ESS now encompasses a wide range of techniques, including unilateral laminotomy for bilateral decompression for lumbar stenosis, paramedian approaches for extraforaminal stenosis, and posterior cervical foraminotomy for radiculopathy. Recent developments have introduced endoscopic transforaminal lumbar interbody fusion, including its application in multilevel disease. Indications have also expanded to conditions requiring urgent treatment, such as cauda equina syndrome and spinal infections. Despite these advances, technical challenges, steep learning curves, and a lack of robust long-term outcome data remain important limitations.Discussion and Conclusion: Future innovation in ESS is likely to be shaped by 3 key areas: AI-based real-time recognition of neural structures, robotic-assisted or remote-controlled endoscopy, and dependable application in multilevel stenosis or unstable spinal conditions. These technologies are anticipated to enhance surgical safety, shorten the learning curve, and optimize patient outcomes. ESS is currently in a transitional phase, evolving rapidly toward a minimally invasive, digitally integrated standard of spinal surgery, with broad potential for expanded clinical application.