Purpose: This article aims to evaluate the appropriateness of endoscopic spine surgery as a treatment for symptomatic lumbar spinal canal stenosis (LSS). It seeks to inform patients and clinicians by comparing its efficacy and recovery profile to traditional open decompression and defining the specific patient characteristics that make one an ideal candidate.

Methodology: A prospective analysis was conducted on the 20 consecutive patients with lumbar spinal canal stenosis who underwent Percutaneous Stenoscopic Lumbar Decompression (PSLD). Outcome measures included operative time, complications, hospital stay, and patient-reported outcomes using the Visual Analog Scale (VAS) for leg pain and the Oswestry Disability Index (ODI) preoperatively and at 3-month & 6-month follow-up.

Results: The cohort demonstrated a significant reduction in mean VAS leg pain (from 8.1 to 1.8) and ODI scores (from 68% to 16%). The majority of procedures (93%) were discharged after short hospital stay (one day). The complication rate was 8.3%, comprising one dural tear that converted to open surgery, no surgical site infections was observed.  Reoperation was needed for 2 patients, 1 patient developed discitis.

Conclusion: Endoscopic spine surgery is an appropriate and advantageous surgical option for a well-defined subset of patients with lumbar canal stenosis—specifically, those with refractory symptoms from focal compression and stable spinal anatomy. It represents a shift towards value-based spine care, emphasizing tissue preservation and rapid recovery. A thorough evaluation by a surgeon experienced in both endoscopic and traditional techniques is essential to determine individual appropriateness.