{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:25:21Z","timestamp":1791617121024,"version":"4.3.4"},"reference-count":15,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Full endoscopic spine surgery (FESS) offers an ultra-minimally invasive solution for addressing many different degenerative spine pathologies. While FESS has demonstrated strong evidence for faster recovery, reduced hospital stays, fewer complications, and potentially lower overall costs, FESS remains underutilized in low-income countries (LICs). This narrative review synthesizes the existing literature to evaluate access to FESS in LICs, highlighting challenges such as a lack of trained neurosurgeons and orthopedic surgeons, insufficient access to specialized equipment, capital costs, and limited representation in research. A systematic literature search identified only a handful of relevant studies, underscoring the scarcity of data on FESS in LICs. Findings reveal stark disparities in training opportunities and equipment availability, with less than 25% of LIC facilities equipped with the essential tools. This review advocates for international collaboration, increased funding, cost reduction, and targeted research to bridge these gaps. Innovative solutions such as virtual training platforms may help overcome current limitations. Addressing these challenges is essential to leveraging FESS\u2019s potential to mitigate the burden of spinal disorders in LICs and advance global health equity.<\/jats:p>","DOI":"10.3390\/jcm14113876","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T10:21:49Z","timestamp":1748859709000},"page":"3876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Are There Unique Barriers and Opportunities for Access to Endoscopic Spine Surgery in Low-Income Countries? A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3249-9657","authenticated-orcid":false,"given":"Adham M.","family":"Khalafallah","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Diez","sequence":"additional","affiliation":[{"name":"College of Medicine, Florida State University, Tallahassee, FL 32306, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Di","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saqib","family":"Hasan","sequence":"additional","affiliation":[{"name":"Golden State Orthopedics and Spine, Oakland, CA 94609, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Konakondla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, PA 17822, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama N.","family":"Kashlan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10034, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Derman","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Texas Back Institute, Plano, TX 75093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Mahan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4230-4411","authenticated-orcid":false,"given":"Raymond J.","family":"Gardocki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Telfeian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph P.","family":"Hofstetter","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Basil","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.21037\/atm.2020.02.175","article-title":"Global Low Back Pain Prevalence and Years Lived with Disability from 1990 to 2017: Estimates from the Global Burden of Disease Study 2017","volume":"8","author":"Wu","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_2","unstructured":"(2025, January 01). World Bank Blogs. Available online: https:\/\/blogs.worldbank.org\/en\/opendata\/world-bank-country-classifications-by-income-level-for-2024-2025."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/2192568218770769","article-title":"Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume","volume":"8","author":"Ravindra","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.spinee.2023.01.009","article-title":"Full-Endoscopic Spine Surgery Diminishes Surgical Site Infections\u2014A Propensity Score-Matched Analysis","volume":"23","author":"Mahan","year":"2023","journal-title":"Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Burkett, D., and Brooks, N. (2024). Advances and Challenges of Endoscopic Spine Surgery. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051439"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"30S","DOI":"10.1177\/2192568220958403","article-title":"Is Less Really More? Economic Evaluation of Minimally Invasive Surgery","volume":"11","author":"Chung","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.spinee.2024.11.007","article-title":"Full-Endoscopic Spinal Decompression or Discectomy Show Benefits Regarding 30-Day Readmission Rates When Compared to Other Spine Surgery Techniques: A Propensity Score Matched Analysis","volume":"25","author":"Leyendecker","year":"2025","journal-title":"Spine J."},{"key":"ref_8","first-page":"65","article-title":"Economics of Less Invasive Spinal Surgery: An Analysis of Hospital Cost Differences between Open and Minimally Invasive Instrumented Spinal Fusion Procedures during the Perioperative Period","volume":"65","author":"Lucio","year":"2012","journal-title":"RMHP Risk Manag. Healthc. Policy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1016\/j.wneu.2021.03.152","article-title":"Disparities in the Geographic Distribution of Neurosurgeons in the United States: A Geospatial Analysis","volume":"151","author":"Rahman","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2023.9.JNS231615","article-title":"Mapping the Global Neurosurgery Workforce. Part 1: Consultant Neurosurgeon Density","volume":"141","author":"Gupta","year":"2024","journal-title":"J. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2019.12.FOCUS19853","article-title":"The Impact of African-Trained Neurosurgeons on Sub-Saharan Africa","volume":"48","author":"Karekezi","year":"2020","journal-title":"Neurosurg. Focus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"374","DOI":"10.14245\/ns.2245042.521","article-title":"A 30-Year Worldwide Research Productivity of Scientific Publication in Full-Endoscopic Decompression Spine Surgery: Quantitative and Qualitative Analysis","volume":"20","author":"Liu","year":"2023","journal-title":"Neurospine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.14245\/ns.2244574.287","article-title":"Global Trends and Hotspots in Endoscopic Discectomy: A Study Based on Bibliometric Analysis","volume":"19","author":"Wu","year":"2022","journal-title":"Neurospine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.1016\/j.wneu.2023.09.108","article-title":"The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries","volume":"180","author":"Tayal","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.4103\/jcvjs.jcvjs_39_23","article-title":"Endoscopic versus Microscopic Discectomy for Pathologies of Lumbar Spine: A Nationwide Cross-Sectional Study from a Lower-Middle-Income Country","volume":"14","author":"Pahwa","year":"2023","journal-title":"J. Craniovertebral Junction Spine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3876\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:44:21Z","timestamp":1760031861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113876"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113876","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]}}}