Spinal endoscopy: Techniques, indications and limitations.

Spinal endoscopy is a major advance in spinal surgery, offering a minimally invasive alternative to traditional techniques. Since the first attempts at indirect visualization of the spinal canal in the 20th century, numerous technological advances have extended the applications of endoscopy, from treating herniated discs to lumbar fusion. Two main techniques are used: uniportal, with a single incision for instruments and endoscope, and biportal, inspired by arthroscopy, using two separate incisions. Uniportal techniques are precise and allow minimal approaches, ideal for simple procedures, while biportal techniques offer better maneuverability for more complex procedures. Spinal endoscopy has proven effective in treating compressive lumbar pathologies: herniated discs, canal or foraminal stenosis, and medullary compression in cervical and thoracic pathologies. It considerably reduces postoperative morbidity and ensures rapid recovery, less pain and fewer infectious complications. However, the learning curve for these techniques is a significant challenge, requiring experience and specialized training. Among other limitations, there is an increased risk of hematoma, transient dysesthesia and accidental durotomy. The high cost of specialized equipment is also a barrier to widespread adoption, although savings are achieved via shorter hospital stay. Despite these challenges, spinal endoscopy is becoming increasingly well-established, with future prospects linked to technological improvements and surgeon training. LEVEL OF EVIDENCE: 4.