Endoscopic Spine Surgery: Navigating the Learning Curve

Abstract

Endoscopic spine has been routinely performed worldwide for nearly 30 years and there is an extensive body of peer reviewed literature that demonstrates clinical effectiveness [1-8]. The progression of surgical techniques for the treatment of spinal disease towards more effective, less invasive, and less costly care is influenced by academic, regulatory, financial, and consumer driven factors [9-11]. Inertia created by the current CPT based system for reimbursement for surgical services has delayed the development of endoscopic procedures for spinal surgery in the United States. This area of spine surgery has historically not seen the same investments in instrumentation, training, and techniques as other surgical subspecialties such as arthroscopic and laparoscopic surgery. The recent introduction of a CPT code for the reimbursement of endoscopic treatment of herniated discs and symptomatic spinal stenosis in the lumbar spine has resulted in an increased interest in this area of minimally invasive spine surgery. The appropriate standards for teaching endoscopic techniques in surgical training programs or adopting the same techniques into an established surgical practice have not been formally defined [12,13].