Endoscopic Spine Surgery: A Scoping Review of the Literature.

Abstract

Study Design/SettingScoping review.ObjectiveTo map the landscape of endoscopic spine surgery research, identify areas of clinical application, and highlight evidence gaps to guide future studies.MethodsFollowing PRISMA-ScR guidelines, systematic searches were performed across MEDLINE, EMBASE, CINAHL, and Cochrane Library (January 1, 2010-September 22, 2024). Eligible studies involved adults undergoing uniportal or biportal endoscopic spine surgery. Non-English studies, case reports (<5 patients), and abstracts were excluded. Two reviewers independently screened studies, with conflicts resolved by the senior author.ResultsA total of 1193 studies including 877 285 patients were identified, with publications increasing markedly over the past decade. Most studies were low-level evidence, primarily case series (49.3%) and retrospective cohorts (33.2%). Clinical effectiveness without comparison groups was common (35.3%). Lumbar disc herniation (47.3%) and uniportal endoscopy (83.9%) were the most studied pathology and technique, respectively. The transforaminal approach (50.4%) was more frequently evaluated than the interlaminar approach (30.0%). Outcomes often included pain scores (85.5%) and complication/readmission rates (79.5%). Few studies examined learning curve (0.8%), economic impact (0.7%), or neuromonitoring (0.5%). Research on enabling technologies such as navigation, robotics, and augmented reality accounted for 3% of studies.ConclusionsThe literature on spine endoscopy is expanding but remains dominated by low-level evidence focused on lumbar uniportal transforaminal approaches. High-quality studies are needed to advance the field.