Endoscopic Spine Surgery: Evidence Maturity and the Path Forward in the United States

➢ As has been shown by higher-level evidence, endoscopic spine surgery (ESS) provides clinical outcomes comparable with those of microscopic and tubular techniques for lumbar disc herniation and spinal stenosis. ➢ The cervical and thoracic ESS evidence base has been limited, with a lack of contemporary multicenter randomized trials and overreliance on single-center retrospective data. ➢ U.S. adoption has been constrained by a steep learning curve, limited training pathways, and reimbursement challenges, despite increasing interest and fellowship exposure. ➢ The economic viability of ESS is facility-dependent, with higher disposable costs possibly offset by reduced hospital resource utilization. Migration of spine surgery into ambulatory surgery centers may also create additional opportunities for ESS adoption. ➢ Broader U.S. integration will require standardized training, multi-institutional outcome registries, and alignment with value-based payment models, such as the 2026 Medicare Transforming Episode Accountability Model (TEAM) program.