Editors’ Introduction: State-of-the-Art Techniques in Endoscopic Spine Surgery ================================================================================ * Hyeun-Sung Kim * Choon-Keun Park * Choll W. Kim In the modern era, surgery in many fields has made rapid progress through endoscopic surgery. Given the proximity of critical anatomic structure, including the spinal nerves that raise significant safety concerns, the adoption of spinal endoscopy has been gradual.1 However, the increase in the elderly population and patient expectations to resume rapid function after spine surgery have led to a drive toward less invasive surgical approaches, including endoscopic surgery.2,3 Endoscopic spine surgery was initially limited to discectomy, but with the development of surgical techniques and instruments, it is now applied to endoscopic decompression and fusion, and the scope is expanding from the lumbar spine to the cervical and thoracic spines.4–8 In this endoscopic spine surgery special issue of the *International Journal of Spine Surgery*, contributors from across the globe discuss the present and future of spinal endoscopy, which is rapidly developing. We appreciate the reviewer team for their hard work on this special issue. As is often the case in medicine and technology, things that seem to last forever change suddenly one day. It is time to prepare for the next generation of spine therapy.9 ## Footnotes * Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. * Declaration of Conflicting Interests Choll Kim reports that he is a consultant for Elliquence. The remaining authors report no conflicts of interest in this work. * This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS. To see more or order reprints or permissions, see [http://ijssurgery.com](http://ijssurgery.com). ## References 1. 1. Kim M , Kim HS , Oh SW , et al . Evolution of spinal endoscopic surgery. Neurospine. 2019;16(1):6–14. doi:10.14245/ns.1836322.161. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.1836322.161&link_type=DOI) 2. 2. Kim HS , Wu PH , Jang IT . Development of endoscopic spine surgery for healthy life: to provide spine care for better, for worse, for richer, for poorer, in sickness and in health. Neurospine. 2020;17(Suppl 1):S3–S8. doi:10.14245/ns.2040188.094. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.2040188.094&link_type=DOI) 3. 3. Chung AS , Wang JC . The Rationale for Endoscopic Spinal Surgery. Neurospine. 2020;17(Suppl 1):S9–S12. doi:10.14245/ns.2040104.052. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.2040104.052&link_type=DOI) 4. 4. Krzok G . Transforaminal endoscopic surgery: outside-in technique. Neurospine. 2020;17(Suppl 1):S44–S57. doi:10.14245/ns.2040128.064. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.2040128.064&link_type=DOI) 5. 5. Fiani B , Siddiqi I , Reardon T , et al . Thoracic endoscopic spine surgery: a comprehensive review. Int J Spine Surg. 2020;14(5):762–771. doi:10.14444/7109. [Abstract/FREE Full Text](http://ijssurgery.com//lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiaWpzcyI7czo1OiJyZXNpZCI7czo4OiIxNC81Lzc2MiI7czo0OiJhdG9tIjtzOjI0OiIvaWpzcy8xNS9zdXBwbF8zL1M1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 6. 6. Kim HS , Wu PH , Jang IT . Lumbar endoscopic unilateral laminotomy for bilateral decompression outside-in approach: a proctorship guideline with 12 steps of effectiveness and Safety. Neurospine. 2020;17(Suppl 1):S99–S109. doi:10.14245/ns.2040078.039. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.2040078.039&link_type=DOI) 7. 7. Wagner R , Haefner M . Uniportal endoscopic lumbar interbody fusion. Neurospine. 2020;17(Suppl 1):S120–S128. doi:10.14245/ns.2040130.065. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.14245/ns.2040130.065&link_type=DOI) 8. 8. Li ZZ , Wang JC , Cao Z , Zhao HL , Lewandrowski KU , Yeung A . Full-endoscopic oblique lateral lumbar interbody fusion: a technical note with 1-year follow-up. Int J Spine Surg. 2021;15(3):504–513. doi:10.14444/8072. [Abstract/FREE Full Text](http://ijssurgery.com//lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiaWpzcyI7czo1OiJyZXNpZCI7czo4OiIxNS8zLzUwNCI7czo0OiJhdG9tIjtzOjI0OiIvaWpzcy8xNS9zdXBwbF8zL1M1LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 9. 9. Kim HS . Next generation of spinal surgery: endoscopic spinal surgery. World Neurosurg. 2021;145:590. doi:10.1016/j.wneu.2020.09.052. [CrossRef](http://ijssurgery.com//lookup/external-ref?access_num=10.1016/j.wneu.2020.09.052&link_type=DOI)