The Use of Endoscopy in Spine Surgery

Over the past three decades, endoscopic spine surgery has become a credible minimally invasive alternative to open and microsurgical approaches, driven by two distinct technical families: uniportal (monoportal) endoscopy, rooted in the pioneering work of Kambin and Hijikata and later structured through transforaminal (Yeung, Hoogland) and interlaminar (Ruetten) systems, and unilateral biportal endoscopy (UBE), first described by De Antoni in 1996 and subsequently developed in South Korea from the 2000s onward. It appeared in France around 2020, with a rapid increase in the number of spine surgeons practicing this technique. This presentation retraces this historical evolution and examines the paradigm shift it represents for spine surgeons, drawing on the "benefit zone" concept described by Hasan et al., which maps the expected patient benefits (reduced tissue damage, blood loss, and length of hospital stay) against the complexity and invasiveness of the procedure. Particular attention is given to the learning curve specific to each technique: recent literature analyses (CUSUM, risk-adjusted CUSUM) help define the indications best suited to a surgeon's level of experience. Data from a recent French national survey, showing a marked preference for the biportal approach, illustrate the current challenges of adopting these techniques in France.