Full-Endoscopic Spine Surgery : Its Roles and Limitations

Endoscopic spine surgery is the perfect culmination of the concept of minimally invasive spine surgery. Among the various endoscopic spine procedures, full-endoscopic spine surgery (FESS) is an endoscopic technique characterized by the performance of the entire spinal procedure via the percutaneous approach using a uniportal working-channel endoscope with continuous saline perfusion. FESS effectively decompresses the tissues and allows for instrumentation while preserving the normal musculoskeletal structures. It also has fewer complications and enables quicker return to work. However, potential disadvantages include its steep learning curves and limited indications. Previously, the indications for endoscopic procedures had been limited to soft disc herniations or focal neural impingement, with most degenerative spinal diseases other than disc herniation being considered contraindications. However, owing to the remarkable advancements in endoscopic technology, nearly all degenerative spinal diseases, including spinal stenosis and instability, can currently be treated using FESS. Furthermore, the application of spinal endoscopes has expanded to other spinal disorders, including infections, traumas, and tumors. Unfortunately, the steep learning curve and technical limitations of FESS cannot be overlooked by most standard spine surgeons. To ensure the clinical success of endoscopic procedures in actual clinical practice, a comprehensive understanding of the core properties of working channel endoscopes is necessary to facilitate the learning process. With the ongoing development of endoscopic technology, endoscopic surgery can be expected to become the standard treatment approach for all degenerative spinal diseases in the near future.