## 4 Discussion
The objectives of surgery include the identification of the causative pathogen--particularly when laboratory tests are inconclusive--debridement of infected tissues, stabilization of the affected spinal segments, and overall improvement in the patient's quality of life. Various surgical techniques have been employed, ranging from needle biopsies and flow-through drainage to more invasive procedures such as discectomy, Extreme Lateral Interbody Fusion (XLIF), and posterior spinal fixation [35; 36]. Recently, the focus has shifted towards minimally invasive techniques, with endoscopic spinal surgery gaining traction as a viable alternative to traditional open procedures. Several studies have highlighted the potential advantages of endoscopic techniques in the management of spinal infections. For instance, [PERSON] et al. (2023) [25] compared fluoroscopy-guided percutaneous transpedicular biopsy with posterolateral endoscopy in a cohort of 30 patients, finding that the endoscopic approach had a higher rate of pathogen identification (14 out of 30 cases) compared to the fluoroscopy-guided method (12 out of 30 cases). These findings are echoed in other studies that demonstrate the efficacy of endoscopic procedures not only in pathogen identification but also in significantly reducing pain, as measured by visual analogue scale (VAS) scores. Further comparisons between various surgical techniques reveal that endoscopic approaches often result in better outcomes in terms of pain relief and functional recovery. For example, [PERSON] et al. [26] reported a significant reduction in VAS scores--from a pre-operative mean of 9.25 to 0.67 one year post-operatively--following antibiotic instillation and posterior disccectomy in 12 patients. Similarly, [PERSON] et al. [37] observed an improvement in VAS scores from 6.8 pre-operatively to 1.0 post-operatively in a study involving 30 patients treated with XLIF and posterior fixation. The use of endoscopic techniques in these cases not only facilitated pathogen identification but also contributed to more rapid and sustained pain relief. In another study, [PERSON] et al. (2007) [8] evaluated posterolateral spinal endoscopic surgery in 15 patients, achieving pathogen identification in 11 out of 15 cases. This study reported a reduction in VAS scores from 8.6 pre-operatively to 2.5 one week post-operatively, with further improvement to 1.4 at three weeks. Such outcomes suggest that endoscopic approaches may offer a superior alternative to more invasive surgical techniques, particularly in terms of patient recovery and post-operative pain management. [PERSON] et al. (2019) [15] further explored the benefits of percutaneous endoscopic debridement combined with percutaneous pedicle screw fixation in 45 patients. Their findings were notable, with pathogen identification in 32 cases and a reduction in VAS scores from 7.5 pre-operatively to 0.5 during a follow-up period of six to 24 months. These results underscore the potential of minimally invasive endoscopic surgery not only for effective infection control but also for achieving long-term pain relief and functional improvement. The efficacy of endoscopic procedures is also supported by our own case series, which demonstrated significant improvements in patient outcomes even when the causative pathogen was not identified. In one case, despite the absence of pathogen identification, the patient experienced a marked reduction in pain and an improvement in quality of life following surgery. Another patient with a known pathogen from a previous operation showed similar improvements. These findings suggest that the benefits of endoscopic surgery may extend beyond mere pathogen identification, offering substantial clinical value in terms of pain management and overall patient well-being. In addition to these individual studies, several systematic reviews and meta-analyses have reinforced the growing role of spine endoscopy in the management of spinal infections. For instance, a systematic review by [PERSON] et al.