Adoption of Endoscopic Spine Surgery: A 6-Year National Utilization Analysis

Descriptive study.

To determine national trends in utilization of endoscopic spine surgery from 2017 to 2022.

Endoscopic spine surgery (ESS) has emerged as a potential, minimally invasive approach to treat certain symptomatic spinal pathology. The benefits of ESS have not been well established; however, small case series suggest possible improvement in postoperative complications rates, decreased length of stay, and improved outcomes in comparison to traditional techniques. Despite this, adoption of ESS is not widespread in the United States.

Patients undergoing ESS were identified using the CPT code 62380 in the PearlDiver M165Ortho database from 2017 to 2022. Demographic factors extracted included: (1) age, (2) sex, (3) Elixhauser comorbidity index (ECI), (4) Charlson comorbidity index (CCI), (5) geographic region of surgery, (6) type of insurance plan (Commercial, Medicaid, Medicare), and (7) timing of the surgery.

A total of 1886 patients who have undergone ESS were identified from 2017 to 2022. The utilization of ESS peaked in 2018 but reached a plateau after. The largest proportion of patients receiving ESS were over the age of 70 (30%) with 51% female (n=968). In addition, the majority of ESS were performed in the South (47.8%), and most payers utilized commercial health insurance (70.9%). Comorbidity indices for ESS patients were tracked: mean ECI +/- SD: 5.04+/-3.68; median ECI: 4 and mean CCI: 2.06; median CCI: 2.

The limited widespread adoption of ESS can be multifactorial. As with all new technologies, there is hesitation for early adoption, additionally the lack of standardized surgeon education, limited scope of procedure, and need for advanced surgical tools serve as possible reasons contributing to the trends in usage.