Why Isn’t Endoscopic Spine Surgery Available Everywhere Yet? We Asked 78 Surgeons Around the World

Posted on: August 5th, 2026 by Our Team

If you’ve researched minimally invasive options for a herniated disc, spinal stenosis, or other degenerative spine condition, you may have come across endoscopic spine surgery (ESS) — a technique that uses a camera and small instruments through an incision as small as about 1 centimeter, instead of the larger openings required for traditional open surgery. Patients who are candidates for it tend to appreciate the smaller incision, shorter hospital stay, and faster return to daily life. So a natural question follows: if it offers these advantages, why isn’t it more widely available?

We wanted a real answer, not a guess. So our team surveyed 78 spine surgeons across 17 countries — members of two of the field’s leading endoscopic spine societies — about how ESS is actually being used in practice, what’s helping it grow, and what’s holding it back.

Why we looked at this

Most published research on endoscopic spine surgery focuses on how well it works for a given patient, or how its results compare with other techniques. That research matters, but it doesn’t answer a more practical question: why hasn’t a technique with this much evidence behind it become the standard everywhere? We suspected the barriers had less to do with the surgery itself and more to do with training pathways, equipment costs, and reimbursement — factors that shape whether a surgeon can offer ESS at all, regardless of outcomes for any individual patient.

To find out, we distributed an anonymous, voluntary survey to members of two major endoscopic spine societies from June to July 2025, hearing back from 78 surgeons and residents across North America, Europe, Asia, and beyond. We asked about experience level, case volume, costs and reimbursement, training received, and outlook for the field’s future.

What we found

Interest in ESS is high and getting higher. Most surgeons predicted strong future patient and colleague interest, and a large majority described themselves as optimistic or very optimistic about the technique’s growth in their country over the next five years.

But several real obstacles are slowing that growth:

Cost. Roughly 4 in 10 surgeons pointed to both upfront equipment investment and ongoing disposable costs as barriers. Tellingly, when asked what would change their mind, the large majority said they’d switch to ESS if costs were brought in line with existing techniques — suggesting the technique itself isn’t the obstacle, the price tag is.

Training. Formal ESS training during residency or fellowship remains limited. Most surgeons learned the technique later in their careers, through industry-sponsored workshops or one-on-one mentorship rather than structured programs — a path that works, but one where the learning curve depends heavily on who happens to be nearby to teach it.

Institutional support. Close to 40% of respondents said their hospital or institution offered no real support for building an ESS program — whether operating room time, equipment budget, or administrative buy-in.

Reimbursement, especially in the US. US-based surgeons reported significantly lower confidence that ESS reimbursement matches open surgery compared with international colleagues, and many said only a small share of their ESS cases were covered under Medicare or Medicaid. US surgeons also rated equipment costs and reimbursement as bigger barriers than surgeons practicing outside the US.

Experience runs the opposite direction. Surgeons outside the US were more likely to describe themselves as “expert” in ESS, while US-based surgeons were more likely to describe themselves as beginners — a gap that lines up with the training and institutional differences above.

What this means if you’re considering endoscopic spine surgery

If your surgeon offers endoscopic spine surgery, that’s not a small thing. Our survey suggests it usually reflects a deliberate investment — in specialized equipment, in seeking out training not yet built into standard residency curricula, and often in absorbing costs that reimbursement doesn’t fully cover. Availability can vary meaningfully from one practice, hospital, or region to another, not because the technique doesn’t work, but because of the financial and structural hurdles surgeons described in this survey.

If ESS isn’t offered where you’re being treated, that doesn’t mean it isn’t a good option for your condition — it may simply reflect the access gaps this survey identified. It’s worth asking any surgeon you’re considering about their specific ESS training and experience, since our data shows real variation by region.

Why we’re sharing this

We believe patients deserve to understand not just what a technique can do clinically, but why they may or may not have access to it. Publishing this kind of health-systems research is part of how we hold ourselves accountable to closing that gap rather than quietly accepting it. Our practice has continued investing in endoscopic training and equipment specifically because we think the barriers identified here are worth overcoming, not reasons to wait.

If you’d like to know whether endoscopic spine surgery could be an option for your condition, request a consultation or explore our research page to see the full body of outcomes and health-systems research behind our surgical recommendations.

FAQ

Why isn’t endoscopic spine surgery offered at every hospital?
Our global survey found that equipment costs, limited formal training during residency, and inconsistent institutional support are the main reasons ESS hasn’t spread more widely — not a lack of evidence that it works.

Does endoscopic spine surgery cost patients more out of pocket?
Reimbursement varies. Most surgeons in our survey said insurance coverage for ESS is similar to open surgery, though some — especially in the US — reported it can run lower, which is one reason coverage and costs are worth confirming with your specific insurer and surgeon before scheduling.

How do I know if my surgeon has real experience with endoscopic techniques?
It’s reasonable to ask directly about case volume and training background. Our survey found meaningful variation in self-reported expertise between regions, so experience isn’t something to assume — it’s something to ask about.

Is endoscopic spine surgery only used for simple procedures?
No. While it started with basic discectomies, surgeons in our survey reported using ESS for decompressions and interbody fusions, across the lumbar, cervical, and even thoracic spine.