Endoscopic Spine Surgery: The Next Evolution for Interventional Spine and Pain Physicians?

John K. Hong, M.D. | 5/10/2025

Introduction

The landscape of spine care is evolving rapidly, with minimally invasive and motion-preserving techniques at the forefront. Among these, endoscopic spine surgery has emerged as a transformative approach for treating disc herniations, spinal stenosis, and other degenerative conditions. While traditionally associated with orthopedic and neurosurgeons, there is a compelling case for interventional spine and pain management physicians to play a central role in performing these procedures.

The Overlap in Skill Sets

Interventional spine specialists possess a unique blend of competencies that align exceptionally well with the requirements of endoscopic surgery:

• Fluoroscopic navigation: Pain physicians are extensively trained in using real-time imaging to target spinal pathology with high precision.

• Percutaneous access and needle-based techniques: From transforaminal epidural injections to radiofrequency ablations, these specialists are adept at minimally invasive spinal access.

• Understanding of spinal pain generators: Pain physicians often have a more nuanced appreciation for axial, radicular, and referred pain patterns, allowing them to tailor surgical decisions to symptom drivers, not just radiographic findings.

• Outpatient care models: Most pain physicians already operate in ambulatory surgery center (ASC) environments, making the transition to same-day endoscopic spine procedures seamless.

  
  

Clinical Benefits of Endoscopic Surgery in the Hands of Pain Specialists

1. Earlier Intervention, Faster Recovery

   Pain physicians are typically the first to identify patients who fail conservative care but aren’t yet candidates for open surgery. Offering endoscopic decompression allows timely intervention before chronicity and disability worsen.

2. Minimally Invasive by Design

   Endoscopic spine surgery naturally complements the conservative, tissue-sparing philosophy of interventional pain care. With incisions as small as 5–10 mm and minimal disruption to stabilizing structures, it preserves motion and biomechanics—key goals for pain physicians.

3. Improved Continuity of Care

   Pain specialists are often longitudinal providers, managing patients before and after procedures. By incorporating endoscopic surgery, they can deliver a full spectrum of care—from diagnosis to intervention to post-op rehabilitation—without fragmentation.

   
   

Training Pathways Are Now Accessible

Historically, lack of exposure and institutional barriers limited endoscopic training for non-surgeons. Today, this is changing:

• Fellowships and certification courses in endoscopic spine surgery are now open to interventional pain physicians.

• Leading device manufacturers and academic programs offer cadaver labs and proctorships tailored for physicians with fluoroscopic and percutaneous experience.

• Regulatory frameworks increasingly support these procedures in outpatient centers, where many pain specialists already operate.

  
  

Evidence-Based and Patient-Driven

The demand for less invasive, outpatient spine solutions is only growing. Studies now support the safety and efficacy of endoscopic spine procedures for:

• Lumbar disc herniation

• Lateral recess and foraminal stenosis

• Discogenic low back pain

• Failed back surgery syndrome (FBSS)

When done by appropriately trained physicians, outcomes are comparable to traditional techniques—with lower complication rates, reduced opioid use, and faster return to activity.

Collaboration, Not Competition

This is not a turf war—it’s a collaborative evolution. Surgeons, pain physicians, physiatrists, and anesthesiologists each bring unique perspectives to spine care. Allowing interventional pain physicians to offer endoscopic procedures fosters:

• Multidisciplinary integration

• Improved access to care

• Reduced wait times

• Better patient outcomes through earlier intervention

  
  

Conclusion

Interventional spine and pain physicians are uniquely positioned to lead the expansion of endoscopic spine surgery. Their experience in image-guided access, minimally invasive procedures, and longitudinal patient management aligns seamlessly with this modern surgical approach. With proper training, support, and collaboration, pain physicians can help bring the benefits of endoscopic spine surgery to a wider population—safely, effectively, and efficiently.