Vit Kotheeranurak, Jin-Sung Kim, Inbo Han, Hyeun-Sung Kim, Thanapol Ultarnpatumros, Chinati Puinongpo, Javier Quillo-Olvera, Lei Jiang, Christoph Siepe, Worawat Limthongkul, Weerasak Singhatanadgige, Surachat Jaroenwareekul
Neurospine 2026;23(3):605-624. Published online July 31, 2026
Objective Endoscopic spine surgery (ESS) has expanded rapidly, but existing spine registries do not consistently capture ESS-specific technical variables, ultra-early recovery trajectories, selective imaging validation, or dissemination-related learning-curve effects. This review synthesizes established spine registry models, contemporary consensus initiatives, and digital follow-up approaches to propose a candidate ESS-specific registry framework and preliminary Minimum Data Set (MDS) for future validation.
Methods A structured narrative review was conducted on national and multinational spine registries, relevant consensus initiatives, and digital follow-up models. Sources were reviewed with emphasis on governance, data architecture, workflow design, patient-reported outcome measures (PROMs) integration, follow-up structure, data linkage, validation strategies, and implementation feasibility.
Results Established registries provide a methodological foundation for benchmarking, complication surveillance, longitudinal PROM capture, and real-world evidence generation. However, ESS requires modular augmentation of existing registry infrastructures to capture approach-specific operative details, early recovery, selective imaging phenotypes, and governance-controlled maturity indicators. The proposed candidate MDS is organized into 4 domains: (1) baseline case-mix and phenotyping, (2) procedure-specific technical and perioperative variables, (3) selective quantitative imaging and morphometric validation, and (4) structured longitudinal outcome surveillance. The framework prioritizes an essential core dataset while separating recommended, optional, research-oriented, and governance-controlled modules, including digitally enabled early follow-up, opioid-related outcomes, radiation exposure, advanced imaging, and learning-curve variables.
Conclusion A candidate ESS-specific registry framework may support harmonized data capture, real-world evidence generation, quality feedback, and future registry-based research. Formal Delphi consensus, multicenter feasibility testing, and staged integration into existing spine registry infrastructures are required before broader implementation.
Objective To evaluate early postoperative mobility after lumbar decompression using real-time location system (RTLS)-derived objective metrics and to explore differences in mobility patterns between biportal endoscopic decompression and open decompression.
Methods This retrospective cohort study included 323 patients who underwent lumbar decompression for degenerative lumbar spinal stenosis between March 2020 and May 2024. RTLS sensors embedded in wristbands continuously recorded patient mobility during postoperative days (PODs) 1–4. Primary RTLS-derived outcomes included total walking distance, mean walking speed, and active movement ratios (top 20% and top 50%). Between-group comparisons were performed using nonparametric tests. Propensity score matching and multivariable median quantile regression adjusting for age, American Society of Anesthesiologists physical status, and preoperative mobility were conducted.
Results RTLS identified differences in early postoperative activity patterns between surgical approaches. In adjusted analyses, activity-intensity–based metrics, particularly the top 20% activity ratio, remained significantly higher in the biportal endoscopic decompression group across multiple PODs. Subgroup analyses demonstrated minimal differences after single-level decompression, whereas activity-based differences were more frequently observed in multilevel procedures.
Conclusion RTLS-based continuous monitoring detected differences in early postoperative activity patterns following lumbar decompression. These findings support the role of RTLS as an objective tool for assessing early functional recovery in spine surgery.
Objective This systematic review and meta-analysis aimed to compare endoscopic discectomy (ED) with microdiscectomy (MD) for lumbar disc herniation, evaluating patient-reported outcomes, perioperative parameters, and complications to determine if ED could replace MD as the gold standard.
Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we searched PubMed, Embase, Scopus, and Web of Science (January 2000–June 2025) for randomized controlled trials (RCTs) and prospective cohort studies comparing MD with ED subtypes (transforaminal endoscopic lumbar discectomy [TELD], interlaminar endoscopic lumbar discectomy [IELD], and unilateral biportal endoscopy [UBE]). Outcomes included Oswestry Disability Index (ODI), visual analogue scale (VAS) for pain, operative time, hospital stay, complications, and recurrence. Pooled mean differences and odds ratios (ORs) were calculated using random-effects models, with subgroup analyses by ED subtype. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools.
Results Seventeen studies (9 RCTs, 8 cohorts; n=3,115) were included. ED significantly reduced hospital stay (mean difference, -2.43 days; 95% CI, -3.62 to -1.23; p<0.05) and showed greater short-term ODI improvement (mean difference, 2.13; 95% CI, 0.58–3.67). No differences were observed in operative time, long-term ODI, or VAS scores. ED had lower wound complications but a higher recurrence risk with TELD (OR, ~2.0). High heterogeneity (I²>95%) and limited long-term data (>2 years) were noted.
Conclusion ED offers perioperative advantages and comparable efficacy but does not surpass MD due to TELD’s increased recurrence risk. IELD and UBE are promising alternatives, but MD remains the benchmark. Long-term RCTs are needed.
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Objective Lesions of the ventral craniovertebral junction are difficult to access owing to their deep location and proximity to critical neurovascular and pharyngeal structures. In this study, we aimed to describe the surgical technique and clinical outcomes of the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions and highlight key considerations regarding approach selection, airway management, and occipitocervical stabilization.
Methods We retrospectively reviewed 7 patients who underwent the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions. The analysis included preoperative planning for surgical access, intraoperative technique, postoperative management, airway and nutritional strategies, and the need for occipitocervical fixation. One representative case is presented to illustrate key technical steps.
Results Of the 7 patients, 6 had neoplastic lesions and 1 had basilar invagination. Despite a relatively large mean lesion size of 39.4 mm, subtotal or greater resection was achieved in 5 of the 6 tumor cases. Occipitocervical fixation was performed in 2 cases. Two patients underwent prophylactic tracheostomy because of anticipated airway compromise. Of the 5 orally intubated cases, 3 were extubated immediately and 2 by postoperative day 2. Oral feeding resumed by day 10 in 6 cases. No postoperative infections or cerebrospinal fluid leakage occurred. One patient experienced transient velopharyngeal insufficiency, which resolved spontaneously.
Conclusion The endoscopic endonasal transnasopharyngeal approach is a safe and effective option for ventral craniovertebral junction lesions when appropriately selected. Careful preoperative evaluation and individualized management of airway and spinal stability are essential for favorable outcomes.
Objective Unilateral biportal endoscopic (UBE) spine surgery is a minimally invasive technique that uses continuous irrigation to improve visualization and control bleeding. Effective water pressure management is crucial for patient safety, particularly at the cervical and thoracic levels where spinal cord injury risk is higher. However, real-time pressure monitoring remains underexplored. This study evaluates the impact of real-time water pressure monitoring on safety during UBE surgery.
Methods A prospective study was conducted involving 20 patients undergoing UBE lumbar spine surgery. Patients were divided into 2 groups based on the irrigation system: gravity-based or infusion pump. Real-time water pressure was monitored using a digital sensor throughout surgery. Each procedure was categorized into 3 phases: phase I, working space preparation; phase II, laminectomy; phase III, flavectomy, dura exposure, and discectomy. Data was analyzed according to the type of irrigation system and surgical phase.
Results The mean water pressure in the surgical field during UBE spine surgery was 17.98± 8.07 mmHg, with no significant differences between surgical phases. However, the infusion pump system maintained significantly lower mean pressure (12.10±3.51 mmHg) compared to the gravity-based system (23.86±6.97 mmHg, p=0.001). The infusion pump system consistently maintained a significantly lower mean water pressure compared to the gravity-based system.
Conclusion Real-time water pressure monitoring during UBE surgery enhances safety by enabling improved control of pressure within the surgical field. Both the gravity-based and infusion pump systems safely maintained working space pressure, with the pump system showing significantly lower pressure levels.
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Mazda Farshad, Jana Felicitas Schader, Alexandra Stauffer, Carl Moritz Zipser, Najmeh Kheram, José Miguel Spirig, Marie-Rosa Fasser, Jonas Widmer, Vincent Hagel
Neurospine 2025;22(2):583-591. Published online June 30, 2025
Objective Endoscopic spine surgery implies possibly severe complications of the central nervous system, from headache to seizures and autonomic dysreflexia. These adverse events might be due to increased intracranial pressure (ICP), presumably induced by increased spinal intra-/epidural pressure caused by fluid irrigation. This study was designed to perform interlaminar endoscopic lumbar discectomy (IELD) at different irrigation fluid settings while monitoring its effect on intra-/epidural and ICPs, with and without dural tears.
Methods Spinal intradural pressures were measured by introducing catheters through a sacral approach to human cadavers’ lumbar, thoracic, and cervical levels. Additionally, an epidural probe was placed at L3–4. ICP was measured by an intraventricular probe. IELD was performed at L3–4, and the effect of varying irrigation pressures by different endoscopic pump systems and gravity-based irrigation on intra-/epidural and ICP pressures was measured before and after durotomy at L3–4.
Results Intradural pressure at L3–4 correlated linearly with increasing irrigation pressure, irrespective of the used pump system (median pressure increase at 100-mmHg irrigation pressure: system I: 7 mmHg, r=0.94, p=0.002; system II: 7 mmHg, r=0.89, p=0.017) or gravity (8 mmHg, r=0.93, p=0.242). This effect was also seen intradurally at the thoracic/cervical spine, epidural, and intracranial level, and was even more pronounced with the maneuver of outflow-occlusion and a dural tear present.
Conclusion While performing IELD, pump pressures correlated linearly to intra-/epidural pressures and ICPs. Pressures did not rise to concerningly high levels without outflow-occlusion, even with increased pump pressures. In the presence of a dural tear, higher pump pressures exacerbated by occlusion may lead to deleterious intradural and ICP elevations.
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Objective This study aimed to compare the clinical outcomes of patients with AOSpine A3 or A4 thoracolumbar fractures presenting with neurological deficits treated with endoscopic decompression combined with percutaneous pedicle screws fixation (endoscopic minimally invasive surgery, EMIS) or conventional open surgery (OS).
Methods Data of patients with AOSpine A3 or A4 thoracolumbar fractures with neurological deficits who were treated with EMIS or OS between June 2019 and July 2021 were extracted from the electronic database. Various clinical outcomes were compared between the 2 cohorts.
Results Among the 231 patients who were followed up for more than 2 years, 107 were in the EMIS cohort and 124 were in the OS cohort. Compared with the OS cohort, the EMIS cohort had longer operative time (p<0.05), but the intraoperative blood loss, incision length and hospital stay were significantly reduced (p<0.05). At both postoperative and final follow-up assessments, the EMIS cohort demonstrated significantly better visual analogue scale and Oswestry Disability Index outcomes compared to the OS cohort (p<0.05). Both cohorts maintained similar correction of spinal canal erosion rate, percentage of anterior vertebral height and sagittal Cobb angle after surgery and at the last follow-up (p>0.05). According to American Spinal Injury Association classification, the 2 cohorts had similar neurological recovery at the last follow-up (p>0.05).
Conclusion In comparison to OS, EMIS treatment for AOSpine A3 or A4 thoracolumbar fractures with neurological deficits has shown comparable clinical efficacy while significantly reducing surgical trauma.
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Objective The upper lumbar region has distinctive anatomical characteristics that contribute to the challenges of performing discectomy. We introduce far-lateral transforaminal unilateral biportal endoscopic (UBE) lumbar discectomy for central or paracentral disc herniations in the upper lumbar region.
Methods We conducted retrospective review of the patients who underwent a far-lateral transforaminal UBE lumbar discectomy at our institution from January 2018 to September 2024. The electronic medical records, operative records, and radiologic images of the patients were reviewed.
Results A total of 27 patients underwent far-lateral transforaminal UBE lumbar discectomy for central or paracentral disc herniations in the upper lumbar region. The patient had a mean age of 54.0 ± 13.7 years. Operation was performed at the L1–2 level in 3 patients (11.1%), L2–3 in 9 patients (33.3%), and L3–4 in 15 patients (55.6%). The patients were followed-up for a mean of 27.7 ± 19.3 months. The Oswestry Disability Index was significantly decreased from 36.3 ± 6.8 preoperatively to 3.7 ± 3.3 at last follow-up (p < 0.001). The visual analogue scale (VAS) back was significantly decreased from 7.8 ± 0.9 preoperatively to 3.1 ± 0.6 postoperative day 2 (p < 0.001). The VAS leg was significantly decreased from 8.1 ± 0.8 preoperatively to 2.3 ± 0.7 postoperative day 2 (p < 0.001).
Conclusion The far-lateral transforaminal UBE lumbar discectomy would be a viable surgical option for upper lumbar disc herniations.
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Methods This retrospective cohort study included patients who underwent TETD or MD for symptomatic TDH and had a minimum follow-up of 1 year. Cost analysis included direct costs (primary and secondary hospital costs), indirect costs (lost wages due to work absence), total costs (direct + indirect), and cost-effectiveness (cost per quality-adjusted life year [QALY] and incremental cost-effectiveness ratio [ICER]). Clinical outcomes included patient-reported outcome measures (Oswestry Disability Index [ODI], 36-item Short Form health survey [SF-36]), QALY gained, and reoperation and readmission rates at 1 year. TETD and MD groups were compared for outcome measures.
Results A total of 111 patients (57 TETD, 54 MD) were included. The direct ($6,270 TETD vs. $7,410 MD, p < 0.01), indirect costs ($1,250 TETD vs. $1,450 MD, p < 0.01), total costs ($7,520 TETD vs. $8,860 MD, p < 0.01), and cost per QALY ($31,333 TETD vs. $44,300 MD, p < 0.01) were significantly lower for TETD compared to MD. ICER of TETD was found to be -$33,500. At 1 year, TETD group showed significantly greater improvement in ODI (46% vs. 36%, p < 0.01) and SF-36 (64% vs. 53%, p < 0.01) and significantly greater QALY gained (0.24 vs. 0.2, p < 0.01) compared to MD group. No significant difference was found in reoperation and readmission rates.
Conclusion TETD demonstrated significantly better clinical outcomes, lower overall costs, and better cost-effectiveness than MD in appropriately selected patients of symptomatic TDH.
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Objective Full endoscopic cervical surgery (FECS) is an evolving minimally invasive approach for treating cervical spine disorders. This systematic review synthesizes current evidence on the clinical outcomes and patient perspectives associated with FECS, specifically evaluating its safety, efficacy, and overall patient satisfaction.
Methods A systematic search of the PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published between January 2000 and September 2024 that reported on clinical outcomes or patient perspectives related to FECS were included. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool and the Cochrane Risk of Bias tool. Inclusion criteria encompassed randomized controlled trials, prospective cohort studies, retrospective studies, and observational studies focused on adult populations undergoing FECS for cervical spine surgery.
Results The final synthesis included 30 studies. FECS was associated with significant reductions in both cervical and radicular pain, as well as meaningful functional improvements, measured by standardized clinical scales such as the Neck Disability Index and visual analogue scale. Patient satisfaction rates were consistently high, with most studies reporting satisfaction exceeding 85%. Complication rates were low, primarily involving transient neurological deficits that were typically resolved without the need for further intervention. Nonrandomized studies generally presented a moderate risk of bias due to confounding and selection, whereas randomized controlled trials exhibited a low risk of bias.
Conclusion FECS is a safe and effective minimally invasive surgical option for cervical spine disorders associated with substantial pain relief, functional improvement and high levels of patient satisfaction.
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Response to the letter to the editor: Inconsistencies in obesity criteria: implications for systematic reviews on endoscopic spine surgery Wongthawat Liawrungrueang, Watcharaporn Cholamjiak, Peem Sarasombath, Yudha Mathan Sakti, Pang Hung Wu, Meng-Huang Wu, Yu-Jen Lu, Lo Cho Yau, Zenya Ito, Sung Tan Cho, Dong-Gune Chang, Kang Taek Lim Asian Spine Journal.2026; 20(1): 211. CrossRef
Full-Endoscopic Posterior Cervical Foraminotomy and Discectomy for Cervical Disc Hernia With Unilateral Radiculopathy Idris Gurpinar, Mehmet Yigit Akgun, Furkan Almas, Ozkan Ates Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 149. CrossRef
Clinical and Functional Outcomes of Posterior Endoscopic Decompression for Symptomatic Cervical Disc Herniation Adam Mahendra Teja, Muhammed Anzar, Cheol Wung Park Cureus.2026;[Epub] CrossRef
Ultrasound-guided brachial plexus hydrodissection combined with acupotomy release for the treatment of cervical spondylotic radiculopathy: a multicenter retrospective study Xiang Shang, Guo-Rui Luan, Yang-Chun Song, Fen Zhang, San-Bing Wu, Kai Geng, Hou-Shan Fang, Wei Wei, Zhen-Ya Wang, Han-Qing Zhao, Yong-Hui Yang, De-Hong Meng Frontiers in Aging Neuroscience.2026;[Epub] CrossRef
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Navigated Minimally Invasive Cervical and Cervicothoracic Fixation: A Technical Note on Surgical Technique and Proposed Classification Spyridon Komaitis, Konstantinos Zygogiannis, Sotirios Karatzoglou, Dimitrios Klitsinikos, Dritan Pasku, Khalid Salem Cureus.2025;[Epub] CrossRef
Objective This study aimed to compare the clinical and comprehensive radiological outcomes of 3 types of endoscopic decompression surgery: unilateral biportal endoscopic lumbar decompression (UBELD), microendoscopic laminotomy (MEL), and percutaneous endoscopic lumbar decompression (PELD).
Methods Patients with single-level lumbar spinal stenosis without instability were included in this multicenter retrospective study. Visual analogue scale (VAS) scores for each extremity, VAS back pain, and Japanese Orthopaedic Association (JOA) scores at preoperative and postoperative 1st, 6th, and 12th months were used as clinical outcome measures. In order to compare the radiological results of the patients, bilateral superior articular distance (SAD), bilateral lateral recess height (LR height), bilateral lateral recess angle (LR angle), and cross-sectional spinal canal area values were measured.
Results Eighty patients in the UBELD group, 73 patients in the MEL group, and 62 patients in the PELD group were included in the study. There was a statistically significant improvement in VAS scores and JOA scores in all groups compared to the preoperative period. At the 12th month postoperatively, the highest lateral decompression values on the approach side were determined as MEL (SAD: 4.1 mm, LR angle: 38.8°, LR height: 4.0 mm), followed by UBELD (SAD: 3.6 mm, LR angle: 36.2°, LR height: 3.3 mm) and PELD (SAD: 3.0 mm, LR angle: 21.7°, LR height: 2.3 mm), respectively. For the contralateral side, the highest lateral recess decompression values were listed as UBELD > MEL > PELD.
Conclusion Effective decompression can be performed using all endoscopic techniques in lumbar spinal stenosis. However lateral recess decompression values were found to be better in UBELD and MEL techniques, compared to PELD.
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Comparison of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and conventional open TLIF in degenerative lumbar spine disease: a radiological, clinical, and laboratory study Yunus Şamil Gönüldenk, Mustafa Özyıldıran, Abdullah Merter Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef
Cost-effectiveness analysis of the early transition from microscopic to biportal endoscopic unilateral laminectomy bilateral decompression Sung-Eun Kwon, Hangeul Park, Noah Hong, Woojin Kim, Jungbo Sim, Ho Sung Myeong, Seunghoon Lee, Jun-Hoe Kim, Chang-Hyun Lee, Fon-Yih Tsuang, Chi Heon Kim Medicine.2026; 105(34): e50400. CrossRef
Bispectral Index Monitoring in Endoscopic Lumbar Spine Surgery: Retrospective Analysis of Central Nervous System Complications Abdullah Merter, Mustafa Özyıldıran, Fatih Kurt, Menekşe Özçelik World Neurosurgery.2025; 200: 124230. CrossRef
Comparison of 0-degree and 30-degree endoscopes in unilateral biportal endoscopic decompression for lumbar spinal stenosis: Which preserves the facet joint better? Abdullah Merter, Mustafa Özyıldıran Journal of Orthopaedic Surgery.2025;[Epub] CrossRef
Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis of the First-Year Learning Curve for Unilateral Biportal Endoscopy in a Neurosurgeon with Endoscopic Skull Base Experience Eren Yılmaz, Atakan Emengen, Aykut Gökbel, Ayse Uzuner, Mehmet Korkmaz, Sibel Balci, Abdullah Merter, Savas Ceylan World Neurosurgery.2025; 204: 124523. CrossRef
Objective This study aims to investigate the anatomical relationship among the nerve roots, intervertebral space, pedicles, and intradural rootlets of the cervical spine for improving operative outcomes and exploring neuroventral decompression approach in posterior endoscopic cervical discectomy (PECD).
Methods Cervical computed tomography myelography imaging data from January 2021 to May 2023 were collected, and the RadiAnt DICOM Viewer Software was employed to conduct multiplane reconstruction. The following parameters were recorded: width of nerve root (WN), nerve root-superior pedicle distance (NSPD), nerve root-inferior pedicle distance (NIPD), and the relationship between the intervertebral space and the nerve root (shoulder, anterior, and axillary). Additionally, the descending angles between the spinal cord and the ventral (VRA) and dorsal (DRA) rootlets were measured.
Results The WN showed a gradual increase from C4 to C7, with measurements notably larger in men compared to women. The NSPD decreased gradually from the C2–3 to the C5–6 levels. However, the NIPD showed an opposite level-related change, notably larger than the NSPD at the C4–5, C5–6, and C7–T1 levels. Furthermore, significant differences in NIPD were observed between different age groups and genders. The incidence of the anterior type exhibited a gradual decrease from the C2–3 to the C5–6 levels. Conversely, the axillary type exhibited an opposite level-related change. Additionally, the VRA and DRA decreased as the level descended, with measurements significantly larger in females.
Conclusion A prediction of the positional relationship between the intervertebral space and the nerve root is essential for the direct neuroventral decompression in PECD to avoid damaging the neural structures. The axillary route of the nerve root offers a safer and more effective pathway for performing direct neuroventral decompression compared to the shoulder approach.
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Bone tunnel approach for cervical spondylotic radiculopathy with uncovertebral osteophytes Xin Wang, Tao Hu, Bo Lei, Chaofan Qin, Xiang Tan, Changjun Pi, Mingxin Chen, Qingshuai Yu, Si Cheng, Zhengjian Yan European Spine Journal.2026; 35(4): 1848. CrossRef
Acute Radiculopathy After Anterior Cervical Discectomy and Fusion of Cervical Spondylotic Radiculopathy with Cervical Kyphosis: Causes and Prevention Fan He, Zong-xian Feng, Pei-ming Sang, Shi-rong Gu, Bin-hui Chen World Neurosurgery.2026; 206: 124767. CrossRef
This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5–S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin’s triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.
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Endoscopic spinal surgery has gained increasing popularity over the past 10 years. Its muscle-preserving nature, reduction in postoperative pain, and lower complication rates have contributed to the growing number of surgeons adopting this technique year after year. This same progression has led to the application of the technique in oncological pathology, primarily for separation surgeries and biopsies of extradural lesions. However, reports in the literature on the use of this technique to treat intradural spinal tumors remain scarce. To present a case report of a patient with an intradural lesion, compatible with schwannoma, successfully removed using a fully endoscopic technique. A 46-year-old female patient presented with a long-standing history of low back pain and bilateral leg pain. The pain worsened over the past few months before her initial presentation. She also reported experiencing weakness in her feet and intermittent hypesthesia in her legs. Magnetic resonance imaging (MRI) showed a small intradural extramedullary tumor at the L1 level. Given the patient’s young age, the tumor location at the thoracolumbar junction, and the rather small tumor size, a full-endoscopic approach was selected and performed. A step-by-step video of the surgical technique is provided with the manuscript. The current follow-up period is 2.5 years, with the patient remaining asymptomatic. The most recent follow-up MRI, conducted 16 months after the surgery, indicated no signs of recurrence. To our knowledge, this is the first video report providing a step-by-step description of this procedure. More high-quality evidence is needed to properly evaluate the safety and outcomes of this technique.
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