Endoscopic spine surgery (ESS) has evolved as a safe, effective, and efficient alternative for minimally invasive spine surgery (MISS). The innovation of full-endoscopic systems makes definitive decompression surgery through different approaches feasible. The approach can be determined according to the location of the target lesion or the surgeon's preference. During the past 2 decades, ESS has expanded its indications from lumbar to cervical spines. Except for decompression, endoscopy-assisted fusion surgery is also developing. However, ESS is still evolving and has a steep learning curve. The revolution of technologies and ESS techniques will enable surgeons to treat various spinal diseases more practically. In recent years, the application of the computer-assisted navigation system and augmented reality have reformed imaging quality and interpretation. The endoscopic rhizotomy techniques have opened a new way for MISS of chronic low back pain. This review introduces the current indications of ESS and its potential future expansion.
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Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.
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Neurospine 2021;18(2):389-396. Published online June 30, 2021
Objective To evaluate the use of guidelines for lumbar spine fusions among spine surgeons in North America.
Methods An anonymous survey was electronically sent to all AO Spine North America members. Survey respondents were asked to indicate their opinion surrounding the suitability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accordance with North America Spine Society (NASS) guidelines for lumbar fusion were considered NASS-concordant answers. Respondents were considered to have a NASS-concordant approach if ≥ 70% (13 of 18) of their answers were NASS-concordant answers. Comparisons were performed using bivariable statistics.
Results A total of 105 responses were entered with complete data available on 70. Sixty percent of the respondents (n = 42) were considered compliant with NASS guidelines. NASS-discordant responses did not differ between surgeons who stated that they include the NASS guidelines in their decision-making algorithm (5.10 ± 1.96) and those that did not (4.68 ± 2.09) (p = 0.395). The greatest number of NASS-discordant answers in the United States. was in the South (5.75 ± 2.09), with the lowest number in the Northeast (3.84 ± 1.70) (p < 0.01). For 5 survey items, rates of NASS-discordant answers were ≥ 40%, with the greatest number of NASS-discordant responses observed in relation to indications for fusion in spinal deformity (80%). Spine surgeons utilizing a NASS-concordant approach had a significant lower number of NASS-discordant answers for synovial cysts (p = 0.03), axial low back pain (p < 0.01), adjacent level disease (p < 0.01), recurrent stenosis (p < 0.01), recurrent disc herniation (p = 0.01), and foraminal stenosis (p < 0.01).
Conclusion This study serves an important role in clarifying the rates of uptake of clinical practice guidelines in spine surgery as well as to identify barriers to their implementation.
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Repeat Discectomy or Instrumented Surgery for Recurrent Lumbar Disk Herniation: An Overview of French Spine Surgeons’ Practice Pierre-Cyril Cômes, Amandine Gavotto, Zineb Zouakia, Guillaume Lonjon, Aymeric Amelot, Grégory Edgard-Rosa, Bertrand Debono Global Spine Journal.2025; 15(3): 1533. CrossRef
Synergistic enhancement of spinal fusion in preclinical models using low-dose rhBMP-2 and stromal vascular fraction in an injectable hydrogel composite Hye Yeong Lee, Seong Bae An, Sae Yeon Hwang, Gwang Yong Hwang, Hye-Lan Lee, Hyun Jung Park, Joongkyum Shin, Keung Nyun Kim, Sung Won Wee, Sol Lip Yoon, Yoon Ha Materials Today Bio.2025; 30: 101379. CrossRef
Evaluation of GPT-4 concordance with north American spine society guidelines for lumbar fusion surgery Ara Khoylyan, Jason Salvato, Frank Vazquez, Mina Girgis, Alex Tang, Tan Chen North American Spine Society Journal (NASSJ).2025; 21: 100580. CrossRef
Open Midline Decompression with Ligament Reconstruction for Multiple-Level Spinal Stenosis in Elderly Patients Shin-Jae Kim, Sang-Ho Lee, Junseok Bae NeuroSci.2025; 6(1): 18. CrossRef
The Wasteful Neurosurgeon? Ahilan Sivaganesan, Advith Sarikonda, Adam Leibold, James Harrop, Alexander R. Vaccaro, Brent C. James World Neurosurgery.2024; 187: 285. CrossRef
What Is the Value Proposition of Evidence-Based Guidelines? An Application of the Operative Value Index for Lumbar Fusions Advith Sarikonda, Ashmal Sami, Kevin Hines, D. Mitchell Self, Emily Isch, Adam Leibold, Kavantissa M. Keppetipola, Glenn Gonzalez, Daniyal Mansoor Ali, Sara Thalheimer, Joshua Heller, Srinivas Prasad, Jack Jallo, Ashwini Sharan, Alexander R. Vaccaro, Jame World Neurosurgery.2024; 189: e832. CrossRef
Evaluating the Adherence of Large Language Models to Surgical Guidelines: A Comparative Analysis of Chatbot Recommendations and North American Spine Society (NASS) Coverage Criteria Advith Sarikonda, Emily Isch, Mitchell Self, Abhijeet Sambangi, Angeleah Carreras, Ahilan Sivaganesan, Jim Harrop, Jack Jallo Cureus.2024;[Epub] CrossRef
Radiological Outcomes of Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis With and Without Discectomy Hyun-Seo Cho, Se-Hoon Kim, Jeong Su Han, Bum-Joon Kim World Neurosurgery.2023; 175: e1307. CrossRef
Narrative Review of Pathophysiology and Endoscopic Management of Basivertebral and Sinuvertebral Neuropathy for Chronic Back Pain Hyeun Sung Kim, Pang Hung Wu, Il-Tae Jang Journal of Korean Neurosurgical Society.2023; 66(4): 344. CrossRef
Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019 Rahul A. Sastry, Jia-Shu Chen, Belinda Shao, Robert J. Weil, Ki-Eun Chang, Ken Maynard, Sohail H. Syed, Patricia L. Zadnik Sullivan, Joaquin Q. Camara, Tianyi Niu, Prakash Sampath, Albert E. Telfeian, Adetokunbo A. Oyelese, Jared S. Fridley, Ziya L. Gokas JAMA Network Open.2023; 6(7): e2326357. CrossRef
Biomechanical Effect of Disc Height on the Components of the Lumbar Column at the Same Axial Load: A Finite-Element Study Jae-Gyeong Jeong, Sungwook Kang, Gu-Hee Jung, Mingoo Cho, Hyunsoo Kim, Kyoung-Tae Kim, Dong-Hee Kim, Jong-Moon Hwang, V. E. Sathishkumar Journal of Healthcare Engineering.2022; 2022: 1. CrossRef
A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance Young Il Won, Chi Heon Kim, Hee-Pyoung Park, Sun Gun Chung, Woon Tak Yuh, Shin Won Kwon, Seung Heon Yang, Chang-Hyun Lee, Yunhee Choi, Sung Bae Park, John M. Rhee, Kyoung-Tae Kim, Chun Kee Chung Scientific Reports.2022;[Epub] CrossRef
Systematic Review of Current Literature on Clinical Outcomes of Uniportal Interlaminar Contralateral Endoscopic Lumbar Foraminotomy for Foraminal Stenosis Hyeun Sung Kim, Pang Hung Wu, Brian Zhao Jie Chin, Il-Tae Jang World Neurosurgery.2022; 168: 392. CrossRef
Efficacy for Whitlockite for Augmenting Spinal Fusion Su Yeon Kwon, Jung Hee Shim, Yu Ha Kim, Chang Su Lim, Seong Bae An, Inbo Han International Journal of Molecular Sciences.2021; 22(23): 12875. CrossRef
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