The Future of Endoscopic Spine Surgery in the United States: Lifeline or Liability?

Endoscopic spine surgery offers minimally invasive advantages, including reduced tissue disruption, fewer complications, and faster recovery. These benefits are particularly relevant in the treatment of herniated discs and spinal stenosis. Despite these strengths, questions remain regarding its long-term economic sustainability. Thus, it is important to evaluate the economic challenges facing endoscopic spine surgery and identify strategies to support its integration into modern spine care. This perspective examines reimbursement structures, procedural scope, stakeholder incentives, and overlap with pain management. Endoscopic procedures are primarily used for decompression and involve minimal implant utilization, limiting reimbursement and revenue generation. This creates financial pressure across surgeons, ambulatory surgery centers, hospitals, and industry stakeholders. Increasing procedural overlap with pain management further complicates positioning and adoption. Sustained viability will depend on integrating endoscopy into broader surgical workflows, demonstrating measurable value, and aligning reimbursement with clinical performance. Strategic innovation and coordinated stakeholder engagement are essential to securing its future role.