Clinical Outcomes and Future Directions of Endoscopic Cervical Spine Surgery: A Systematic Review With Narrative Insights

Study DesignSystematic Review.ObjectiveEndoscopic cervical spine surgery (ECSS) has emerged as a minimally invasive alternative to traditional open surgery for certain cervical spine disorders. ECSS may offer potential advantages such as reduced tissue trauma, shorter hospital stays, and accelerated functional recovery. Technological advancements have further enhanced its feasibility. The purpose of this article is to review current ECSS approaches, systematically review ECSS for cervical stenosis, and explore future directions of ECSS.MethodsThe PubMed, Embase, and Google Scholar databases were searched systematically until October 20, 2024, adhering to PRISMA guidelines. We searched keywords associated with cervical stenosis, including "endoscopic cervical surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", "cervical endoscopic unilateral laminotomy for bilateral decompression", and "unilateral bilateral endoscopy". We excluded duplicate publications, review articles, preprints, and studies without clinical outcomes or incomplete information. Clinical outcomes and complications were collected.ResultsA total of 12 studies were included with 2 studies being reported twice for having two different ECSS approaches. Each study reported postoperative improvement in clinical outcomes compared to preoperative measurements. The most common complications included dural tears, transient hypesthesia, and CSF leakage.ConclusionECSS is an emerging alternative for treating select cases of symptomatic cervical stenosis and other cervical conditions. Complications differed depending on the approach. Advancements in endoscopic instruments, navigational technologies, and artificial intelligence hold promise for improving preoperative planning, surgical precision, and patient outcomes. The true value of ECSS will require carefully conducted prospective, controlled studies with rigorous assessment of outcomes and complications.