Safety and Complications of Endoscopy-Assisted Anterior Cervical Discectomy and Fusion for Degenerative Cervical Disease: A Preliminary Systematic Review

Objective: This study aimed to review the current evidence on endoscopic techniques used in anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, with a focus on technical characteristics, clinical outcomes, complications, and fusion.Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar were systematically searched for the period from January 2000 to April 2026 in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Clinical studies of endoscopic techniques used in ACDF were eligible for inclusion. Full-endoscopic procedures were distinguished from endoscope-assisted procedures on the basis of the role of the endoscope and instrumentation. Data were synthesized qualitatively, and the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool was used to assess risk of bias. Substantial clinical and methodological heterogeneity precluded meta-analysis.Results: The review included 7 retrospective studies with 502 patients, 264 of whom underwent ACDF using endoscopic techniques. Techniques varied considerably and included mini-open endoscopic assistance, water-mediated techniques, air-water switching, and hybrid endoscopic techniques. Reported complication rates ranged from 0% to 18.2%; fusion rates, when explicitly reported, ranged from 90% to 100%. Most studies reported favorable early clinical and radiographic outcomes. Interpretation was nevertheless limited by heterogeneity in techniques and comparators, inconsistent outcome assessment, variable follow-up, and moderate-to-serious risk of bias.Conclusion: Endoscopic techniques used in ACDF appear technically feasible and have yielded encouraging early outcomes. Full-endoscopic and endoscope-assisted procedures are technically distinct, however, and the current evidence does not establish superiority over conventional ACDF. Standardized terminology and high-quality prospective studies are needed.