The Role of the Endoscope in Spinal Oncology: A Systematic Review of Applications and Systematic Analysis of Patient Outcomes

Introduction: Surgical techniques to treat tumors of the spine often require extensive tissue dissection and bony removal, predisposing patients to elevated risk for perioperative morbidity and mortality. When indicated, minimally invasive surgical techniques may be preferred as they result in less collateral damage and quicker recovery times. Full endoscopic spine surgery (FES) represents an ultra-minimally invasive approach that further minimizes tissue damage. The advantages to the application of FES to treat spinal tumors remain unclear. Methods: Electronic databases were systematically searched for published literature on the application of FES in spinal oncology to assess its utility, safety, and outcomes via Nurick, McCormick, and Frankel grades, visual analog scale, complication rate, duration of surgery, estimated blood loss, length of stay, and mean follow-up. Results: Fifteen articles describing 72 patients met inclusion criteria. The most common approach was the interlaminar approach (40.98%). The most common spinal level was lumbar (38.89%). The most common goal of surgery was gross total resection (82.11%). The average Nurick grade decreased from 2.96 to 0.67. All patients showed an improvement from Frankel grade C or D to grade E except for one. The average visual analog scale score decreased from 9.3 to 1.3. The complication rate was 6.56%. The average length of stay was 55.2 hours. The average estimated blood loss was 49 mL. The average duration of surgery was 121.26 minutes. The mean follow-up was 10.58 months. Conclusion: The utility of FES in spinal oncology is not well understood. Literature results of this technique show promise. Further study is needed to draw definitive conclusions on FES efficacy and safety in spinal oncology.