Runaway cost for surgical spine care has led to increased scrutiny on its
medical necessity. Consequently, the beaurocracy involved in determining coverage for
these services has grown. The call for high-grade clinical evidence dominates the
debate on whether endoscopic surgery has a place in treating painful conditions of the
aging spine. The cost-effectiveness and durability of the endoscopic treatment benefit
are questioned every time technology advances prompt an expansion of its clinical
indications. The authors of this chapter introduce the concept of early-staged
management of spine pain and make the case for personalized spine care focused on
predominant pain generators rather than image-based necessity criteria for surgery
often applied in population-based management strategies. The authors stipulate that
future endoscopic spine care will likely bridge the gap between interventional pain
management and open spine surgery. This emerging field of interventional endoscopic
pain surgery aims to meet the unanswered patient demand for less burdensome
treatments under local anesthesia and sedation. The very young and old patients often
are ignored because their conditions are either not bad enough or too advanced for a
successful outcome with traditional spine care. In this watershed area of spine care, the
authors predict endoscopic spine surgery will thrive and carve out accepted surgical indications in direct competition with pain management and traditional open spine
fusion protocols.
Keywords: Endoscopy future, Pain generators, Personalized spine care, Staged endoscopic pain management.
