Endoscopic spine surgery is reaching a pivotal moment in adoption in the U.S., and it’s well-suited for ASCs. However reimbursement remains a key hurdle for growth.
Multiple hospitals and practices have adopted endoscopic spine in 2025, and some surgeons have built on their existing programs. And the ASC is no exception.
Chad Campion, MD, said he focuses on the outpatient setting in an endoscopic spine fellowship he created for Memphis, Tenn.-based Campbell Clinic.
“Most of what I do is at the surgery center, and almost all of my endoscopic surgeries at the surgery center,” Dr. Campion said. “So fellows get an outpatient and ASC experience as well. It’s really a graduated fellowship where for the first case or two they’re mostly observing me. Then they start to do more and more portions of the procedure.”
The endoscopic technology has been especially beneficial for getting more complex cases in the outpatient setting.
“In the end, my past fellow was doing the procedures from start to finish by himself in an ASC in a timely manner,” Dr. Campion said. “I think it worked out for him to really be comfortable doing the surgeries, and they weren’t the bread and butter starting cases that we recommend people do. He was doing complex surgeries by the end, and was really comfortable doing them.”
However reimbursement, which has been a pain point for spine surgeons, stands in the way of endoscopic spine. Kai-Uwe Lewandrowski, MD, a board member of the International Society for the Advancement of Spine Surgery–Asia Pacific, said part of this is because of the misconception that endoscopic spine is less complex than open spine surgery.
Dr. Lewandrowski’s advocacy work with ISASS has included research to evaluate the relative value of endoscopic spine surgery to traditional or microsurgical decompression
“We examined the unmeasured components of a CPT code — such as the learning curve, stress level, and procedural difficulty,” he said. “The findings were striking: these elements are actually higher in endoscopic surgery than in open decompression. With the endoscope, you’re at the neural elements within a few minutes, whereas in open or microscopic surgery, much more time is spent on patient positioning, exposure, and bleeding control before the critical phase even begins. Surgeons in the survey felt that endoscopic decompression should be reimbursed at about 152% of a single open decompression due to its greater technical and cognitive demands.”
To improve U.S. endoscopic spine adoption, including in ASCs, Dr. Lewandrowski said following global examples.
“The path forward lies in learning from international models — lowering procedural barriers, streamlining approvals, and formally recognizing endoscopic spine surgery as a mainstream surgical discipline performed by surgeons,” he said. “The learning curve is steep: many seasoned spine surgeons describe mastering endoscopy as more challenging than learning a standard open decompression, and in some ways even more technically demanding than a basic fusion. That degree of skill and responsibility deserves appropriate recognition within our reimbursement framework.”
