Innovations in endoscopic spine surgery in the cervical and thoracic spine

Abstract Background: Endoscopic spine surgery, initially focused on the lumbar region, is now being increasingly applied to the cervical and thoracic spine—areas once considered technically challenging because of their complex anatomy and heightened neural and vascular sensitivity. These advancements have led to the development of novel surgical approaches that permit direct targeting of pathology with less tissue disruption, reduced postoperative pain, and shorter hospital stays compared with traditional open procedures. Purpose: The aim of this study was to describe the indications, surgical technique, and clinical and radiographic outcomes of endoscopic approaches to cervical and thoracic spine pathology through a series of representative cases and to contextualize these outcomes within the existing literature, given the relative scarcity of reported experience with endoscopic surgery outside the lumbar spine. Study Design: This is a case series and review of the literature. Methods: Six patients who underwent either cervical or thoracic endoscopic spine surgery for various diagnoses at Seoul Gorden Hospital, Seoul, South Korea, between 2020 and 2024 were reviewed. Preoperative X-rays, as well as preoperative and postoperative MRI scans, were obtained for all patients. Visual analog scale (VAS) scores were recorded preoperatively and postoperatively for all patients. Results: Patients in this study demonstrated clinical and radiographic improvement after surgery. Outcomes for each case were discussed within the context of a literature review. Conclusion: The outcomes in the cases presented in this study, in addition to the literature, suggest that endoscopic cervical and thoracic spine surgery is a safe and reliable approach to addressing several spine pathologies. Although endoscopic cervical and thoracic spine surgery comes with difficulties due to differences in vertebral anatomy and adjacent structures, the literature suggests that their outcomes are favorable and warrant further research and technical optimization. Level of Evidence: Level 4.