| The Evolution and Global Impact of Uniportal Endoscopic Spine Surgery : A Korean Perspective and Historical Legacy |
Jin-Sung Kim
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| Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea |
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Received: July 13, 2026; Revised: August 3, 2026 Accepted: August 14, 2026. Published online: September 1, 2026. |
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| ABSTRACT |
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Uniportal full-endoscopic spine surgery (FESS) has expanded over three decades from percutaneous discectomy to include multilevel decompression, endoscopic interbody fusion (Endo-LIF), spinal infection management, and tumor surgery. The Republic of Korea is a leading contributor to this field: across bibliometric analyses, six of the world’s top ten contributing authors and three of the top five contributing institutions are Korean. This article provides a Korea-centered critical appraisal of uniportal FESS, integrating five domains: Korean academic contributions, Level-I evidence by spinal region, expansion of indications, integration of next-generation technologies (navigation, augmented reality, artificial intelligence, robotics), and structural barriers in health policy and reimbursement. Level-I randomized evidence supports clinical equivalence to microscopic surgery for lumbar disc herniation and lumbar spinal stenosis, with cost-utility data from the Korean National Health Insurance Service showing a cost-per-quality-adjusted-life-year of approximately USD 5,241—well below conventional willingness-to-pay thresholds. Cervical FESS evidence remains limited to two single-center RCTs from 2008–2009, and thoracic FESS data derive from non-randomized multicenter case series showing large perioperative advantages over open surgery. Despite the maturity of the evidence, Korean reimbursement codes have not been updated to reflect modern uniportal techniques, Endo-LIF lacks dedicated coding, and the radiofrequency-related fee schedule still uses 1990s-era valuations. We propose a tiered policy roadmap—short-term code differentiation, mid-term Endo-LIF and navigation-track integration, and long-term registry-based credentialing—to align Korean reimbursement infrastructure with the country’s established academic and clinical leadership in this field. |
| Key Words:
Endoscopy · Spine · Diskectomy, percutaneous · Minimally invasive surgical procedures · Insurance, health, reimbursement · Republic of Korea |
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