Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications.

Background: Radiotherapy for thymoma is delivered post-operatively in selected cases. Given the particular location of the thymic bed and the excellent prognosis, late cardiac toxicities may be an issue. The purpose of this retrospective dosimetric study is to investigate whether intensity-modulated proton beam therapy (IMPT) compared to photon therapy could better spare cardiac substructures, given prespecified dose constraints. Methods: We retrospectively selected patients treated with adjuvant radiotherapy for thymoma in our institution. We manually contoured fourteen cardiac substructures (CSs), with the supervision of a team of cardioradiologists. The photon-based plans were re-optimized in adherence to the volumetric modulated arc therapy (VMAT) technique with specific dose constraints for the new contoured structures. The proton-based plans were optimized in adherence to intensity-modulated proton therapy (IMPT) using the beam spot scanning technique. Results: Twenty-nine patients treated with adjuvant radiotherapy with a prescribed dose of 50 Gy in 25 daily fractions for radically resected thymoma were selected. IMPT demonstrated better sparing of most cardiac substructures in terms of Dmax, Dmean and V5Gy. Finally, IMPT plans more easily achieved the proposed dose constraints. Conclusions: Cardiac substructures can be successfully spared with IMPT. Clinical studies are needed to establish a relationship between dose parameters and the development of cardiac events.

Augmented reality (AR) is an emerging technology in spine surgery with the potential to enhance intraoperative visualization and precision by overlaying virtual images on anatomical structures. This bibliometric review analyzes trends in research and publication growth related to AR in spinal neurosurgery between 2013 and 2024. A search across PubMed identified 267 articles. After screening, we analyzed 98 relevant studies, revealing exponential growth in AR research, with publications increasing from 1 in 2013 to 28 in 2024. The focus of research evolved over the years, with instrumentation being the dominant topic in 2020, and a broader emphasis on multi-domain AR applications in 2024. The United States led in publication output, followed by Germany, Sweden, and Switzerland. The increasing number of studies reflects AR's growing adoption in both specialized and broad spine surgery applications. Although AR has demonstrated its potential to improve surgical precision and education, further research is needed to assess long-term clinical outcomes and overcome barriers to widespread implementation.