Endoscopic spine surgery has evolved significantly since its inception, offering minimally invasive alternatives to traditional open surgery. This review discusses the current state of endoscopic techniques, their clinical applications, and the challenges they face. The origins of endoscopic spine surgery date back to the 1970s, with early innovations by Hijikata and Kambin. Over the decades, advancements in endoscopic technology have enabled more precise and less invasive procedures, with applications across various spinal levels. Endoscopic techniques allow for direct visualization of the spinal canal, reducing tissue damage and improving outcomes. Current techniques include the transforaminal, interlaminar, and cervical approaches, each with specific indications and benefits. These techniques have shown comparable or superior outcomes to traditional methods, with reduced postoperative pain, shorter hospital stays, and lower complication rates. However, challenges remain in widespread adoption, including high initial costs, reimbursement issues, and the need for specialized training. Technological advancements, such as navigation systems, augmented reality, and robotic assistance, are enhancing the precision and safety of endoscopic procedures. Despite these advancements, anatomical limitations, surgical complications, and the learning curve for surgeons pose ongoing challenges. The future of endoscopic spine surgery depends on continued research, technological innovation, and improved training programs to ensure its integration into standard clinical practice.Endoscopic spine surgery has evolved significantly since its inception, offering minimally invasive alternatives to traditional open surgery. This review discusses the current state of endoscopic techniques, their clinical applications, and the challenges they face. The origins of endoscopic spine surgery date back to the 1970s, with early innovations by Hijikata and Kambin. Over the decades, advancements in endoscopic technology have enabled more precise and less invasive procedures, with applications across various spinal levels. Endoscopic techniques allow for direct visualization of the spinal canal, reducing tissue damage and improving outcomes. Current techniques include the transforaminal, interlaminar, and cervical approaches, each with specific indications and benefits. These techniques have shown comparable or superior outcomes to traditional methods, with reduced postoperative pain, shorter hospital stays, and lower complication rates. However, challenges remain in widespread adoption, including high initial costs, reimbursement issues, and the need for specialized training. Technological advancements, such as navigation systems, augmented reality, and robotic assistance, are enhancing the precision and safety of endoscopic procedures. Despite these advancements, anatomical limitations, surgical complications, and the learning curve for surgeons pose ongoing challenges. The future of endoscopic spine surgery depends on continued research, technological innovation, and improved training programs to ensure its integration into standard clinical practice.