Endoscopic spine surgery is pushing past being a novelty in 2025.
In the first half of 2025, hospitals including Martinsburg, W.Va.-based WVU Medicine Berkeley Medical Center, Cleveland-based University Hospitals, Lawrenceville, Ga.-based Northside Hospital Gwinnett and Valdosta, Ga.-based SGMC Health Smith Northview added endoscopic spine surgery to their offerings.
In some cases, it’s individual surgeons who are leading the endoscopic charge at their hospitals. For Xiaofei (Sophie) Zhou, MD, her pitch to University Hospitals was a chance to be a leader.
“We’ll be the first in the area,” Dr. Zhou said. “Being the first in anything means that you get first dibs on all of the patients. You get ahead of the learning curve, and I think everybody wants to advance the field. That’s one of the great things about being at UH — being at a place that really embraces innovation. Endoscopic spine is not our only thing that we push forward with.”
And endoscopic technologies are expanding beyond their initial indications.
“When endoscopic spine surgery was first popularized, it was mostly for discectomies,” Saqib Hasan, MD, said. “I think the big value proposition when endoscopic spinal first came is that with the transferaminal approach. Now we’re finding that you can use it for almost anything. For example I routinely use endoscopy for sacroiliac joint denervation. We published a paper on this in 2024 on the value of utilizing endoscopic techniques for this procedure, and we showed about 70% to 80% improvement after two years. That’s an option for patients that didn’t exist before, because many pain management doctors don’t perform SI joint ablations anymore for insurance purposes, and fusion is the only other option. Utilizing the endoscope allows us to address gaps in treatment.”
In recent months, spine surgeons have debuted endoscopic spine techniques with the Barricaid annular closure implant and Medtronic’s Mazor robot.
As these advances continue, some surgeons are worried about CMS and payer policies.
“Right now, I still see this labeled as experimental,” Sohrab Gollogly, MD, said. “There’s a code from Medicare, but it doesn’t have RVUs associated with it. Almost all insurance companies deny it. So it needs to be actually recognized. And then it needs to be compensated more fairly. One of the big problems that we see at hospitals is the RVUs associated with endoscopic spine surgery in general, are about 1/5 of the RVUs for an equivalent procedure when you’re fusing somebody’s spine. If you’re trying to make a career in which you’re held to certain targets for RVU compensation to meet the criteria for full time employment, it can actually be pretty difficult.”
But despite potential challenges, surgeon interest and patient demand for endoscopic spine surgery isn’t going away anytime soon.
“I think everyone’s starting to ride this endoscopic wave,” Grant Booher, MD, said. “It’s not just a trend at this point, and well on its way to becoming the gold standard of spine surgery. Sometimes it is hard to teach an old dog new tricks. It’s very hard to train your mind and say, ‘OK, let’s change the way that we do this because it’s a little less invasive.’ The first endoscopic microdiscectomies that I did took me three hours. But within three or four cases, I’m now down to an hour or less for most of my cases. The proof is in the pudding.”
