Full-endoscopic lumbar spine surgery using working-channel endoscopes: technical tips for practical effectiveness

Introduction: Full-endoscopic spine surgery (FESS) has emerged as an effective and minimally invasive option for the surgical treatment of degenerative lumbar spine disease. FESS can be characterized as endoscopic spine surgery conducted via the percutaneous uniportal approach using working-channel endoscopes under continuous saline irrigation. Despite available evidence, the clinical application of this endoscopic procedure may require more work for standard spine surgeons. Therefore, this review aims to provide comprehensive technical tips to ensure the practical effectiveness of FESS. Area covered: FESS of the thoracolumbar spine can be performed through the transforaminal and interlaminar approaches according to direction and passing window. Published literature on technical tips and learning were reviewed narratively, after which practical technical pearls were demonstrated specific to the properties of working-channel endoscopes. Expert opinion: Currently, FESS remains a reliable option for achieving successful surgical outcomes in cases of lumbar disk herniation and spinal stenosis, with few complications and rapid recovery. A comprehensive understanding of the core features of working-channel endoscopes is crucial for expediting the learning process. Importantly, the development of specific instruments, surgical approaches, and optics is a continuous process that is necessary for establishing FESS as the standard technique for degenerative lumbar spine disease.