Applications of endoscopic techniques in spinal oncology: A systematic review of the contemporary literature

At the time of its origination, endoscopic spine surgery (ESS) was introduced to advance minimally invasive spine surgical (MISS) techniques, aiming to reduce tissue traumatization and improve clinical outcomes. Initially, ESS was primarily applied to transforaminal diskectomies for treating low back pain and radiculopathy caused by lateral or posterolateral disc herniations. Early challenges included limited visualization, suboptimal camera systems, and restricted maneuverability of rigid endoscopes. Technological advancements, such as angled endoscopes and interlaminar approaches, have led to a broader adoption of ESS, particularly in Asian countries. As ESS gains traction in the United States, its potential applications continue to expand. This systematic review evaluates the safety and efficacy of ESS in the treatment of spinal column tumors.

We conducted a systematic search across three databases following PRISMA guidelines to identify studies describing the use of spinal endoscopy for procedural or diagnostic management (e.g., biopsy) of spinal and vertebral column tumors, including both primary neoplasms and metastatic lesions. Studies were screened based on predefined inclusion and exclusion criteria, and relevant data were extracted for qualitative synthesis.

A total of 24 studies, encompassing 147 patients, met the inclusion criteria. The most commonly treated tumor types included schwannomas (37.4 %), spinal metastases (15.0 %), meningiomas (7.5 %), and osteoid osteomas (6.8 %). Tumors were most frequently located in the lumbar spine (38.8 %), followed by the thoracic (29.9 %), cervical (12.9 %), craniospinal junction (6.8 %), and sacral regions (6.1 %). Surgical outcomes demonstrated a high rate of neurological improvement (100 %) across all cases. Among studies reporting pain scores, postoperative Visual Analog Scale (VAS) scores showed consistent improvement. The mean follow-up duration was 13.6 ± 10.1 months. Complication rates were low (6.8 %), with transient radiculopathy, pseudomeningocele, and postoperative hematoma among the reported adverse events. The overall mortality rate was 10.9 %, primarily reflecting patients with metastatic disease rather than procedure-related deaths.

ESS has demonstrated its utility as a viable and effective option for managing select spinal metastases and intradural-extramedullary tumors of the spinal column. The technique offers minimally invasive access to tumors with low complication rates and meaningful clinical benefits, particularly for frail patients requiring palliative treatment. Future studies with larger cohorts and comparative analyses are needed to further validate ESS as a mainstream approach in spinal oncology.