The History of Endoscopic Posterior Lumbar Surgery

Throughout its evolution, spine surgery has migrated toward less invasiveness. For posterior lumbar surgery, percutaneous techniques together with endoscopic visualization allow for the smallest surgical corridor. Initially, this approach utilized the natural entry point into the spinal canal via the transforaminal approach via Kamin's triangle. The interlaminar endoscopic technique was subsequently developed to address central disc herniations at L5-S1, where the transforaminal approach can be challenging to reach the surgical pathology. More recently, the dual portal posterior lumbar endoscopic technique provides for yet another method of performing posterior lumbar surgery, expanding its versatility, including the treatment of spinal stenosis. In addition to treating disc pathology, percutaneous endoscopic lumbar interbody fusions are now performed in select patients in the ambulatory surgery setting. Despite the dramatic advantages of advanced minimally invasive procedures, the adoption of endoscopic spine surgery in everyday practice has lagged. The main obstacle to adoption appears to be the difficult learning curve of endoscopic surgery combined with the fact that traditional microdiscectomy surgery remains one of the most successful operations in our treatment armamentarium. The successful future of endoscopic spine surgery will depend on our ability to address the learning curve problem. In the future, this problem may be addressed through the use to computer-assisted navigation, robotic assistance, and an integrated operating room suite that improves the efficiencies and ergonomics of increasingly complex surgical treatment strategies.