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Minimally invasive endoscopy in spine surgery: where are we now?

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Endoscopic spine surgery (ESS) is a minimally invasive surgical technique that offers comparable efficacy and safety with less collateral damage compared to conventional surgery. To achieve clinical success, it is imperative to stay abreast of technological advancements, modern surgical instruments and technique, and updated evidence.


To provide a comprehensive review and updates of ESS including the nomenclature, technical evolution, bibliometric analysis of evidence, recent changes in the spine communities, the prevailing of biportal endoscopy, and the future of endoscopic spine surgery.


We conducted a comprehensive review of the literature on ESS for the mentioned topics from January 1989 to November 2022. Three major electronic databases were searched, including MEDLINE, Scopus, and Embase. Covidence Systematic Review was used to organize the eligible records. Two independent reviewers screened the articles for relevance.


In total, 312 articles were finally included for review. We found various use of nomenclatures in the field of ESS publication. To address this issue, we proposed the use of distinct terms to describe the biportal and uniportal techniques, as well as their specific approaches. In the realm of technical advancement, ESS has rapidly evolved from addressing disc herniation and spinal stenosis to encompassing endoscopic fusion, along with technological innovations such as navigation, robotics, and augmented reality. According to bibliometric analysis, China, South Korea, and the USA have accounted for almost three-quarters of total publications. The studies of the biportal endoscopy are becoming increasingly popular in South Korea where the top ten most-cited articles have been published. The biportal endoscopy technique is relatively simple to adopt, as it relies on a more familiar approach, requires less expensive instruments, has a shorter learning curve, and is also well-suited for interbody fusion. The uniportal approach provided the smallest area of soft tissue dissection. While robotics and augmented reality in ESS are not widely embraced, the use of navigation in ESS is expected to become more streamlined, particularly with the emergence of recent electromagnetic-based navigation technologies.


In this paper, we provide a comprehensive overview of the evolution of ESS, as well as an updated summary of current trends in the field, including the biportal and uniportal approaches. Additionally, we summarize the nomenclature used in ESS, present a bibliometric analysis of the field, and discuss future directions for the advancement of the field.

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Data Availability

Data will be available by contacting Jin-sung Kim, the corresponding author, at the above address.


  1. Kang KB, Shin YS, Seo EM (2022) Endoscopic Spinal Surgery (BESS and UESS) versus microscopic surgery in lumbar spinal stenosis: systematic review and meta-analysis. Global Spine J 12:1943–1955.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lin GX, Yao ZK, Zhang X, Chen CM, Rui G, Hu BS (2022) Evaluation of the outcomes of biportal endoscopic lumbar interbody fusion compared with conventional fusion operations: a systematic review and meta-analysis. World Neurosurg 160:55–66.

    Article  PubMed  Google Scholar 

  3. Kim JH, Kim YJ, Ryu KS, Kim JS (2023) Comparison of the clinical and radiological outcomes of full-endoscopic laminotomy and conventional subtotal laminectomy for lumbar spinal stenosis: a randomized controlled trial. Global Spine J, 21925682231155846.

  4. Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, Siepe CJ, Li ZZ, Lokhande PV, Choi G, Ahn Y, Chen CM, Choi KC, Van Isseldyk F, Hagel V, Koichi S, Hofstetter CP, Del Curto D, Zhou Y, Bolai C, Bae JS, Assous M, Lin GX, Jitpakdee K, Liu Y, Kim JS (2023) Full-endoscopic lumbar discectomy approach selection—a systematic review and proposed algorithm. Spine (Phila Pa 1976).

  5. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700.

  6. Hofstetter CP, Ahn Y, Choi G, Gibson JNA, Ruetten S, Zhou Y, Li ZZ, Siepe CJ, Wagner R, Lee JH, Sairyo K, Choi KC, Chen CM, Telfeian AE, Zhang X, Banhot A, Lokhande PV, Prada N, Shen J, Cortinas FC, Brooks NP, Van Daele P, Kotheeranurak V, Hasan S, Keorochana G, Assous M, Hartl R, Kim JS (2020) AOSpine Consensus paper on nomenclature for working-channel endoscopic spinal procedures. Global Spine J 10:111S–121S.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ruetten S, Komp M, Godolias G (2005) An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 30:2570–2578.

    Article  PubMed  Google Scholar 

  8. Heo DH, Son SK, Eum JH, Park CK (2017) Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus 43:E8.

    Article  PubMed  Google Scholar 

  9. Liu X (2019) A novel biportal full endoscopy technique for lumbar lateral recess stenosis: technical report. Clin Spine Surg 32:51–56.

    Article  PubMed  Google Scholar 

  10. Ishihama Y, Morimoto M, Tezuka F, Yamashita K, Manabe H, Sugiura K, Takeuchi M, Takata Y, Sakai T, Maeda T, Nagamachi A, Sairyo K (2022) Full-endoscopic trans-kambin triangle lumbar interbody fusion: surgical technique and nomenclature. J Neurol Surg A Cent Eur Neurosurg 83:308–313.

    Article  PubMed  Google Scholar 

  11. Kim HS, Wu PH, Sairyo K, Jang IT (2021) A narrative review of uniportal endoscopic lumbar interbody fusion: comparison of uniportal facet-preserving trans-kambin endoscopic fusion and uniportal facet-sacrificing posterolateral transforaminal lumbar interbody fusion. Int J Spine Surg 15:S72–S83.

  12. Heo DH, Park CK (2019) Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery. Neurosurg Focus 46:E18.

    Article  PubMed  Google Scholar 

  13. Leu HF, Hauser RK (1996) Percutaneous endoscopic lumbar spine fusion. Neurosurg Clin N Am 7:107–117

    Article  CAS  PubMed  Google Scholar 

  14. Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years' experience. Clin Orthop Relat Res, pp 9–23

  15. Kambin P (1992) Arthroscopic microdiscectomy. Arthroscopy 8:287–295.

    Article  CAS  PubMed  Google Scholar 

  16. Kambin P, O'Brien E, Zhou L, Schaffer JL (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res, pp 150–167

  17. Yeung AT (1999) Minimally invasive disc surgery with the yeung endoscopic spine system (YESS). Surg Technol Int 8:267–277

    CAS  PubMed  Google Scholar 

  18. Choi G, Lee SH, Raiturker PP, Lee S, Chae YS (2006) Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 58:ONS59–68; discussion ONS59–68.

  19. Akbary K, Kim JS, Park CW, Jun SG, Hwang JH (2018) Biportal endoscopic decompression of exiting and traversing nerve roots through a single interlaminar window using a contralateral approach: technical feasibilities and morphometric changes of the lumbar canal and foramen. World Neurosurg 117:153–161.

    Article  PubMed  Google Scholar 

  20. Kim HS, Paudel B, Jang JS, Oh SH, Lee S, Park JE, Jang IT (2017) Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 103:201–209.

    Article  PubMed  Google Scholar 

  21. Jacquot F, Gastambide D (2013) Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? Int Orthop 37:1507–1510.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wang MY, Grossman J (2016) Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus 40:E13.

    Article  PubMed  Google Scholar 

  23. Kolcun JPG, Brusko GD, Wang MY (2019) Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes. Ann Transl Med 7:S167.

  24. Nagahama K, Ito M, Abe Y, Murota E, Hiratsuka S, Takahata M (2019) Early clinical results of percutaneous endoscopic transforaminal lumbar interbody fusion: a new modified technique for treating degenerative lumbar spondylolisthesis. Spine Surg Relat Res 3:327–334.

  25. Heo DH, Hong YH, Lee DC, Chung HJ, Park CK (2020) Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine 17:S129–S137.

  26. Kim JE, Choi DJ (2018) Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg 10:248–252.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Li Y, Dai Y, Wang B, Li L, Li P, Xu J, Jiang B, Lu G (2020) Full-endoscopic posterior lumbar interbody fusion via an interlaminar approach versus minimally invasive transforaminal lumbar interbody fusion: a preliminary retrospective study. World Neurosurg 144:e475–e482.

    Article  PubMed  Google Scholar 

  28. Dowling A, Lewandrowski KU (2020) Endoscopic transforaminal lumbar interbody fusion with a single oblique PEEK cage and posterior supplemental fixation. Int J Spine Surg 14:S45–S55.

  29. Harakuni T, Iwai H, Oshima Y, Inoue H, Kitagawa T, Inanami H, Koga H (2020) Full-endoscopic lumbar interbody fusion for treating lumbar disc degeneration involving disc height loss: technical report. Medicina (Kaunas) 56.

  30. Yin P, Zhang Y, Pan A, Ding Y, Zhang L, Xu C, Yang J, Hai Y (2020) The feasibility for a novel minimally invasive surgery-percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar degenerative diseases: a cadaveric experiment. J Orthop Surg Res 15:387.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gong J, Huang Z, Liu H, Zhang C, Zheng W, Li C, Tang Y, Zhou Y (2021) A modified endoscopic transforaminal lumbar interbody fusion technique: preliminary clinical results of 96 cases. Front Surg 8:676847.

  32. Heo DH, Eum JH, Jo JY, Chung H (2021) Modified far lateral endoscopic transforaminal lumbar interbody fusion using a biportal endoscopic approach: technical report and preliminary results. Acta Neurochir (Wien) 163:1205–1209.

    Article  PubMed  Google Scholar 

  33. Heo DH, Choi WS, Park CK, Kim JS (2016) Minimally invasive oblique lumbar interbody fusion with spinal endoscope assistance: technical note. World Neurosurg 96:530–536.

    Article  PubMed  Google Scholar 

  34. Heo DH, Kim JS (2017) Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus 43:E13.

    Article  PubMed  Google Scholar 

  35. Vaishnav AS, Othman YA, Virk SS, Gang CH, Qureshi SA (2019) Current state of minimally invasive spine surgery. J Spine Surg 5:S2–S10.

  36. Lewandrowski KU, Telfeian AE, Hellinger S, Jorge Felipe Ramirez L, Paulo Sergio Teixeira de C, Ramos MRF, Kim HS, Hanson DW, Salari N, Yeung A (2021) Difficulties, challenges, and the learning curve of avoiding complications in lumbar endoscopic spine surgery. Int J Spine Surg 15:S21–S37.

  37. Kotheeranurak V, Liawrungrueang W, Kuansongtham V, Sriphirom P, Bamrungthin N, Keorochana G, Pruttikul P, Limthongkul W, Singhatanadgige W, Pongmanee S, Arunakul R, Ruangchainikom M, Sasiprapha P, Chitragarn R, Pairuchvej S, Tanasansomboon T, Jitpakdee K (2022) Surgeons’ Perspective, learning curve, motivation, and obstacles of full-endoscopic spine surgery in thailand: results from a nationwide survey. Biomed Res Int 2022:4971844.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Son S, Ahn Y, Lee SG, Kim WK, Yoo BR, Jung JM, Cho J (2021) Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine (Baltimore) 100:e24346.

  39. Ahn Y, Lee S, Son S, Kim H (2021) Learning curve for interlaminar endoscopic lumbar discectomy: a systematic review. World Neurosurg 150:93–100.

    Article  PubMed  Google Scholar 

  40. Chang H, Xu J, Yang D, Sun J, Gao X, Ding W (2022) Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation. Eur Spine J.

    Article  PubMed  Google Scholar 

  41. Cheung PWH, Wong CKH, Lau ST, Cheung JPY (2020) Cost analysis comparison between conventional microsurgical decompression and full-endoscopic interlaminar decompression for lumbar spinal stenosis surgery. J Spine Surg 6:721–728.

  42. Madhavan K, Chieng LO, McGrath L, Hofstetter CP, Wang MY (2016) Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity. Neurosurg Focus 40:E6.

    Article  PubMed  Google Scholar 

  43. Kamson S, Lu D, Sampson PD, Zhang Y (2019) Full-endoscopic lumbar fusion outcomes in patients with minimal deformities: a retrospective study of data collected between 2011 and 2015. Pain Physician 22:75–88

    Article  PubMed  Google Scholar 

  44. Hur JW, Kim JS, Cho DY, Shin JM, Lee JH, Lee SH (2014) Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results. J Neurol Surg A Cent Eur Neurosurg 75:415–421.

    Article  PubMed  Google Scholar 

  45. Akbary K, Kim JS (2021) Recent technical advancements of endoscopic spine surgery with disparate or disruptive technologies and patents. World Neurosurg 145:693–701.

    Article  PubMed  Google Scholar 

  46. Yao Y, Jiang X, Wei T, Yao Z, Wu B, Xu F, Xiong C (2022) A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance. Eur Spine J 31:46–55.

    Article  PubMed  Google Scholar 

  47. Wu J, Ao S, Liu H, Wang W, Zheng W, Li C, Zhang C, Zhou Y (2020) Novel electromagnetic-based navigation for percutaneous transforaminal endoscopic lumbar decompression in patients with lumbar spinal stenosis reduces radiation exposure and enhances surgical efficiency compared to fluoroscopy: a randomized controlled trial. Ann Transl Med 8:1215.

  48. Huang X, Gong J, Liu H, Shi Z, Wang W, Chen S, Shi X, Li C, Tang Y, Zhou Y (2022) Unilateral biportal endoscopic lumbar interbody fusion assisted by intraoperative O-arm total navigation for lumbar degenerative disease: a retrospective study. Front Surg 9:1026952.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Staub BN, Sadrameli SS (2019) The use of robotics in minimally invasive spine surgery. J Spine Surg 5:S31–S40.

  50. Wang TY, Park C, Dalton T, Rajkumar S, McCray E, Owolo E, Than KD, Abd-El-Barr MM (2021) Robotic navigation in spine surgery: Where are we now and where are we going? J Clin Neurosci 94:298–304.

    Article  PubMed  Google Scholar 

  51. Li Y, Wang MY (2021) Robotic-assisted endoscopic laminotomy: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 20:E361.

    Article  PubMed  Google Scholar 

  52. Liounakos JI, Wang MY (2020) Lumbar 3-lumbar 5 robotic-assisted endoscopic transforaminal lumbar interbody fusion: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 19:E73–E74.

    Article  PubMed  Google Scholar 

  53. Kolcun JPG, Wang MY (2019) Endoscopic treatment of thoracic discitis with robotic access: a case report merging two cutting-edge technologies. World Neurosurg 126:418–422.

    Article  PubMed  Google Scholar 

  54. Carl B, Bopp M, Sass B, Voellger B, Nimsky C (2019) Implementation of augmented reality support in spine surgery. Eur Spine J 28:1697–1711.

    Article  PubMed  Google Scholar 

  55. Jamshidi AM, Makler V, Wang MY (2021) Augmented reality assisted endoscopic transforaminal lumbar interbody fusion: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 21:E563–E564.

    Article  PubMed  Google Scholar 

  56. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27:722–731.

    Article  PubMed  Google Scholar 

  57. Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976) 31:E890–E897.

    Article  PubMed  Google Scholar 

  58. Zhao T, Shen J, Zheng B, Huang Y, Jin M, Morizane K, Shao H, Chen X, Zhang J (2021) The 100 most-cited publications in endoscopic spine surgery research. Global Spine J 11:587–596.

    Article  PubMed  Google Scholar 

  59. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939.

    Article  PubMed  Google Scholar 

  60. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29:E326-332.

    Article  PubMed  Google Scholar 

  61. Hwa Eum J, Hwa Heo D, Son SK, Park CK (2016) Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine 24:602–607.

    Article  PubMed  Google Scholar 

  62. Xiu P, Zhang X (2020) Endoscopic spine surgery in China: its evolution, flourishment, and future opportunity for advances. J Spine Surg 6:S49-S53.

  63. Virk SS, Yu E (2017) The top 50 articles on minimally invasive spine surgery. Spine (Phila Pa 1976) 42:513–519.

    Article  PubMed  Google Scholar 

  64. Lin GX, Kotheeranurak V, Mahatthanatrakul A, Ruetten S, Yeung A, Lee SH, Ahn Y, Kim HS, Hofstetter C, Lee JH, Choi KC, Lewandrowski KU, Kim JS (2020) Worldwide research productivity in the field of full-endoscopic spine surgery: a bibliometric study. Eur Spine J 29:153–160.

    Article  PubMed  Google Scholar 

  65. Lin GX, Zhu MT, Kotheeranurak V, Lyu P, Chen CM, Hu BS (2022) Current Status and research hotspots in the field of full endoscopic spine surgery: a bibliometric analysis. Front Surg 9:989513.

  66. Chung AS, Kimball J, Min E, Wang JC (2020) Endoscopic spine surgery-increasing usage and prominence in mainstream spine surgery and spine societies. J Spine Surg 6:S14–S18.

  67. Phan K, Xu J, Schultz K, Alvi MA, Lu VM, Kerezoudis P, Maloney PR, Murphy ME, Mobbs RJ, Bydon M (2017) Full-endoscopic versus micro-endoscopic and open discectomy: a systematic review and meta-analysis of outcomes and complications. Clin Neurol Neurosurg 154:1–12.

    Article  PubMed  Google Scholar 

  68. Li W-S, Yan Q, Cong L (2021) Comparison of endoscopic discectomy versus non-endoscopic discectomy for symptomatic lumbar disc herniation: a systematic review and meta-analysis. Global Spine J 12:1012–1026.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Kim HS, Raorane HD, Heo DH, Yi YJ, Jang IT (2020) Endoscopic spine surgery in Republic of Korea. J Spine Surg 6:S40–S44.

  70. Choi CM (2020) Biportal endoscopic spine surgery (BESS): considering merits and pitfalls. J Spine Surg 6:457–465.

  71. Kim JY, Heo DH (2021) Contralateral sublaminar approach for decompression of the combined lateral recess, foraminal, and extraforaminal lesions using biportal endoscopy: a technical report. Acta Neurochir (Wien) 163:2783–2787.

    Article  PubMed  Google Scholar 

  72. Heo DH, Kim JS, Park CW, Quillo-Olvera J, Park CK (2019) Contralateral sublaminar endoscopic approach for removal of lumbar juxtafacet cysts using percutaneous biportal endoscopic surgery: technical report and preliminary results. World Neurosurg 122:474–479.

    Article  PubMed  Google Scholar 

  73. Kim JE, Choi DJ, Park EJJ, Lee HJ, Hwang JH, Kim MC, Oh JS (2019) Biportal endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J 13:334–342.

  74. Heo DH, Lee DC, Park CK (2019) Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus 46:E9.

    Article  PubMed  Google Scholar 

  75. Zuo R, Jiang Y, Ma M, Yuan S, Li J, Liu C, Zhang J (2022) The clinical efficacy of biportal endoscopy is comparable to that of uniportal endoscopy via the interlaminar approach for the treatment of L5/S1 lumbar disc herniation. Front Surg 9:1014033.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Xu WB, Kotheeranurak V, Zhang HL, Chen ZX, Wu HJ, Chen CM, Lin GX, Rui G (2022) Is biportal endoscopic spine surgery more advantageous than uniportal for the treatment of lumbar degenerative disease? A meta-analysis. Medicina (Kaunas) 58.

  77. Xie YZ, Shi Y, Zhou Q, Feng CQ, Zhou Y, Li T, Yu Y, Fan XH (2022) Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up. J Orthop Surg Res 17:360.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Wang JC, Cao Z, Li ZZ, Zhao HL, Hou SX (2022) Full-endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion with a tubular retractor system: a retrospective controlled study. World Neurosurg 165:e457–e468.

    Article  PubMed  Google Scholar 

  79. Wang JC, Li ZZ, Cao Z, Zhao HL, Zhang M (2022) Technical notes of full endoscopic lumbar interbody fusion with anterior expandable cylindrical fusion cage: clinical and radiographic outcomes at 1-year follow-up. World Neurosurg 158:e618–e626.

    Article  PubMed  Google Scholar 

  80. Zhang H, Xu D, Wang C, Zhu K, Guo J, Zhao C, Han J, Liu H, Ma X, Zhou C (2022) Application of electromagnetic navigation in endoscopic transforaminal lumbar interbody fusion: a cohort study. Eur Spine J 31:2597–2606.

    Article  PubMed  Google Scholar 

  81. Chang M, Wang L, Yuan S, Tian Y, Zhao Y, Liu X (2022) Percutaneous endoscopic robot-assisted transforaminal lumbar interbody fusion (PE RA-TLIF) for lumbar spondylolisthesis: a technical note and two years clinical results. Pain Physician 25:E73–E86

    PubMed  Google Scholar 

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Conceptualization: KJ; Methodology: YL, KJ; Formal analysis and investigation: YL, KJ; Writing—original draft preparation: KJ, KL; Writing—review and editing: KJ, VK, SS; Supervision: J-SK, DHH.

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Correspondence to Jin-sung Kim.

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Jitpakdee, K., Liu, Y., Heo, D.H. et al. Minimally invasive endoscopy in spine surgery: where are we now?. Eur Spine J 32, 2755–2768 (2023).

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