Minimally invasive spine procedures have undergone rapid development during the last decade. Efforts to decrease muscle crush injuries during prolonged retraction, avoid significant soft tissue stripping and minimize bony resection are surgical principles that are employed to prevent iatrogenic instability and provide patients with decreased post-operative pain and disability. Full-endoscopic spine surgery represents a tool for the spine surgeon to provide targeted access to spinal pathology utilizing these principles. Endoscopic techniques have seen over 30 years of evolution and innovation, however, early iterations of these techniques largely focused on transforaminal lumbar microdiscectomies. Currently, endoscopic techniques are utilized for approaching pathology in the cervical, thoracic and lumbar spine. There has been a growing body of literature that not only confirms the efficacy of these procedures but also underscores the advantages these procedures offer with respect to less morbidity and safer complication profiles. Endoscopic decompressions have been utilized in the settings of degenerative spinal stenosis, spondylolisthesis, scoliosis, previous fusion, tumor and infection. Furthermore, endoscopic interbody fusion has also been utilized in the lumbar spine as technology continues to advance. As technological innovation continues to facilitate reproducible surgical technique and expand the indications for use, we believe that endoscopic spine surgical techniques will provide surgeons with a more powerful and less morbid approach to spinal pathology that ultimately elevates the standard of care when treating our patients. We present a brief review of the history of endoscopic spine surgery, an overview of current techniques and review current outcomes of endoscopic spine surgical procedures in the context of an invasiveness/complexity index to elucidate the benefit zone of these newer techniques.

Full endoscopic spine surgery (FESS) offers an ultra-minimally invasive solution for addressing many different degenerative spine pathologies. While FESS has demonstrated strong evidence for faster recovery, reduced hospital stays, fewer complications, and potentially lower overall costs, FESS remains underutilized in low-income countries (LICs). This narrative review synthesizes the existing literature to evaluate access to FESS in LICs, highlighting challenges such as a lack of trained neurosurgeons and orthopedic surgeons, insufficient access to specialized equipment, capital costs, and limited representation in research. A systematic literature search identified only a handful of relevant studies, underscoring the scarcity of data on FESS in LICs. Findings reveal stark disparities in training opportunities and equipment availability, with less than 25% of LIC facilities equipped with the essential tools. This review advocates for international collaboration, increased funding, cost reduction, and targeted research to bridge these gaps. Innovative solutions such as virtual training platforms may help overcome current limitations. Addressing these challenges is essential to leveraging FESS’s potential to mitigate the burden of spinal disorders in LICs and advance global health equity.

Purpose : This systematic review and meta-analysis compares incidental dural tear rates between uniportal and biportal endoscopic lumbar surgeries. Uniportal and biportal techniques represent established minimally invasive approaches, though differential risks for complications such as dural tears warrant thorough investigation. Methods : A comprehensive literature search across Google Scholar, PubMed/MEDLINE, and Cochrane Library identified 67 studies, encompassing 10,491 patients (4,657 biportal, 5,834 uniportal). Results : Initial pooled analysis indicated a higher dural tear incidence in the biportal group (3.16%, 152/4,657) compared to the uniportal group (1.69%, 100/5,834), a statistically significant difference (p < 0.001). However, a more focused meta-analysis of 25 studies revealed no statistically significant difference in pooled dural tear incidences (uniportal: 1.4% [95% CI: 0.3-2.4%] vs. biportal: 1.1% [95% CI: 0.6-1.7%], p = 0.42). Secondary outcomes showed biportal endoscopy associated with slightly shorter operative times, while uniportal surgery correlated with shorter hospital stays. Both approaches yielded comparable functional outcomes. Conclusion : While initial data suggested a difference, the meta-analysis found no significant disparity in dural tear risk. Optimal technique selection, considering patient and surgical factors, remains important for minimizing complications.

Background/Objectives: SPINEHealthie is a smartphone-based application enabling remote patient monitoring, care delivery and standardized collection of patient-reported outcome measures (PROMs). This registry-based analysis evaluates patient satisfaction with the platform across a large, heterogeneous spine surgery cohort. Methods: A total of 1729 thoracolumbar spine surgery cases were eligible for analysis. Among these, 881 (50.9%) completed the in-app feedback survey and constituted the primary feedback cohort. The global app experience was categorized as “Very Good” or “Poor”. Clinical outcomes, i.e., the Visual Analogue Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) were assessed at baseline and in the postoperative period; Δ denotes the change from baseline to two weeks postoperation. Results: Among feedback responders, 800 patients (90.8%) rated their app experience as “Very Good”, while 80.8% of 639 patients with surgical outcome data reported that the surgery met their expectations. However, app experience and surgical outcome expectations were assessed using different items at different postoperative time points. Among patients whose surgery did not meet expectations, 84.6% rated their app experience as “Very Good”. Patients with a “Very Good” app-experience rating demonstrated significantly greater improvement in back pain (ΔVAS Back pain 2.94 vs. 2.13, p = 0.027), leg pain (ΔVAS Leg pain 3.16 vs. 2.14, p = 0.019) and disability (ΔODI 11.00 vs. 2.41, p < 0.001). In the primary model, older age, shorter follow-up duration and smaller ODI improvement were associated with an unfavorable app experience; only the association with age remained consistent across sensitivity analyses. Conclusions: Among feedback responders, SPINEHealthie was associated with a high proportion of favorable global app-experience ratings. Favorable app-experience ratings remained high, even among patients with unmet surgical expectations or failure to achieve the exploratory two-week ODI-improvement threshold, suggesting that perceived platform value is not solely explained by surgical outcome. Older patients and those with limited functional recovery were identified as subgroups that may benefit from targeted onboarding and engagement strategies.