Objective: This study aimed to review the current evidence on endoscopic techniques used in anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, with a focus on technical characteristics, clinical outcomes, complications, and fusion.Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar were systematically searched for the period from January 2000 to April 2026 in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Clinical studies of endoscopic techniques used in ACDF were eligible for inclusion. Full-endoscopic procedures were distinguished from endoscope-assisted procedures on the basis of the role of the endoscope and instrumentation. Data were synthesized qualitatively, and the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool was used to assess risk of bias. Substantial clinical and methodological heterogeneity precluded meta-analysis.Results: The review included 7 retrospective studies with 502 patients, 264 of whom underwent ACDF using endoscopic techniques. Techniques varied considerably and included mini-open endoscopic assistance, water-mediated techniques, air-water switching, and hybrid endoscopic techniques. Reported complication rates ranged from 0% to 18.2%; fusion rates, when explicitly reported, ranged from 90% to 100%. Most studies reported favorable early clinical and radiographic outcomes. Interpretation was nevertheless limited by heterogeneity in techniques and comparators, inconsistent outcome assessment, variable follow-up, and moderate-to-serious risk of bias.Conclusion: Endoscopic techniques used in ACDF appear technically feasible and have yielded encouraging early outcomes. Full-endoscopic and endoscope-assisted procedures are technically distinct, however, and the current evidence does not establish superiority over conventional ACDF. Standardized terminology and high-quality prospective studies are needed.
Objective: Unilateral biportal endoscopy (UBE) and endoscopic spine surgery (ESS) are minimally invasive techniques, but their integration into routine surgical practice remains variable. Factors influencing global adoption, particularly cost, training, reimbursement, and institutional support, remain incompletely characterized. This survey study evaluated ESS practice perspectives among members of 2 international UBE societies, focusing on surgeon expertise, reimbursement models, training exposure, and perceived barriers.Methods: An electronic survey was developed and distributed to spine surgeons affiliated with the European Society of Unilateral Biportal Endoscopy Association and World Unilateral Biportal Endoscopy-America. The questionnaire assessed surgeon demographics, ESS experience, reimbursement patterns, cost-related barriers, training exposure, and expectations for future ESS use. Descriptive statistics were used to summarize response patterns, and subgroup differences were assessed by region.Results: Seventy-eight surgeons responded, most of whom were orthopedic surgeons (60.3%) practicing primarily in private hospitals (57.7%). Half of respondents had 1–5 years of ESS experience, and 34.6% had less than 1 year of experience. Lumbar pathology was treated with ESS by all respondents (100%), whereas cervical (47.4%) and thoracic (38.5%) ESS were less common. Only 7.7% of respondents reported that insurance coverage for ESS was “very easy.” Key barriers included startup costs, limited hospital support, and reimbursement challenges. Nevertheless, 42.3% of respondents reported “very high” patient interest, 41.0% reported “very high” surgeon interest, and 55.1% were “very optimistic” about ESS growth in their country over the next 5 years.Conclusion: This survey identified substantial optimism regarding ESS among members of UBE-focused societies, despite persistent barriers related to training limitations, inadequate reimbursement, and high capital investment. These findings may not be generalizable because the survey was limited to selected UBE-focused societies and did not evenly represent all geographic regions. Expanding formal ESS training, reducing capital and disposable costs, and refining reimbursement models may support broader adoption.
Objective: This study aimed to compare perioperative parameters, radiographic fusion, and patient-reported outcomes (PROs) between transforaminal lumbar interbody fusion (TLIF) performed with cement-augmented fenestrated pedicle screws (CAFPSs) and TLIF performed with conventional noncemented pedicle screws (NCPSs) in patients with osteopenia or osteoporosis.Methods: Eighty patients who underwent TLIF for degenerative spinal stenosis and instability with radicular symptoms were reviewed retrospectively. Forty patients treated with CAFPS were matched 1:1 with 40 patients treated with NCPS according to age, sex, body mass index, number of fused levels. Perioperative parameters included operative time, blood loss, transfusion rate, and postoperative morphine consumption. Radiographic outcomes included interbody fusion assessed with the Bridwell classification. PROs included visual analog scale scores for back and leg pain, the Oswestry Disability Index, and neurogenic symptom score. All patients had at least 24 months of follow-up, with a mean follow-up duration of 28.6±6.3 months.Results: Operative time was significantly longer in the CAFPS group than in the NCPS group (334±106 minutes vs. 254.0±98.1 minutes, p<0.001). Postoperative morphine consumption was significantly lower in the CAFPS group than in the NCPS group (7.13±13.6 mg vs. 19.1±21.3 mg, p<0.01). Both groups showed significant postoperative improvement in PROs, with no significant between-group differences at any time point. Interbody fusion rates were comparable between groups throughout follow-up. At the 2-year follow-up, Bridwell grade I fusion was achieved in 38 patients (95.0%) in the CAFPS group and 36 patients (90.0%) in the NCPS group (p=0.396).Conclusions: In TLIF, CAFPSs provided radiographic and functional outcomes comparable to those of conventional pedicle screws and were associated with lower early postoperative opioid requirements. Cement augmentation may be an effective fixation strategy in patients with compromised bone quality, particularly when satisfactory fixation cannot be achieved with conventional techniques alone.
Cervical dumbbell schwannomas are usually managed with open or minimally invasive microsurgical approaches, and endoscopic removal of these tumors has not been previously reported. To our knowledge, this is the first case series describing the feasibility of unilateral biportal endoscopic (UBE) removal of cervical dumbbell schwannomas. Two consecutive patients with cervical dumbbell schwannomas presenting with hemiparesis underwent UBE removal. After laminotomy and medial facetectomy, the extradural tumor was first entered through epineurial and perineurial incisions and disconnected in the subperineurial space. The tumor was then dissected and removed along the established subperineurial plane. The intradural component was subsequently delivered through the dural sleeve from the extradural side. All steps were performed through the same biportal incisions using a dual-tower setup. No instrumented fusion was required. Gross total resection was achieved in one case, and subtotal resection with a residual intradural lesion was achieved in the other. Both patients had full neurological recovery. Asymptomatic occlusion of the nondominant vertebral artery occurred in one case. No cerebrospinal fluid leak, pseudomeningocele, or wound complication was observed. Both patients were followed for more than 1 year, with no tumor recurrence or progression. In the subtotal resection case, the residual intradural lesion was treated with adjuvant stereotactic radiosurgery. This case series demonstrates the technical feasibility of UBE removal of cervical dumbbell schwannomas without instrumented fusion. However, the present experience also highlights important limitations, including vertebral artery occlusion and incomplete intradural removal in a 2-patient series. This approach should therefore be regarded as an emerging technique that requires further refinement of surgical technique and instrumentation rather than as an established alternative.
