## 4 Discussion  
Our study investigates the role of minimally invasive spinal endoscopy in the management of spinal infections, such as spondylodiesitis and post-operative infections. The findings demonstrate that spinal endoscopy offers several advantages, including reduced tissue trauma, shorter hospital stays, faster recovery, and outcomes comparable to traditional open surgery. Importantly, the pathogen identification rates were high, and the technique effectively managed pain and improved functional status. However, complications like residual infections and the need for re-operations, though infrequent, highlight areas for optimization. This research reinforces the growing potential of spinal endoscopy as a viable alternative to open surgery in managing complex spinal infections. The study addresses whether spinal endoscopy can serve as a safe and effective alternative to traditional surgical techniques for treating spinal infections, offering similar or superior clinical outcomes with fewer complications. The study contributes original insights into the application of spinal endoscopy for infections, a field where research is limited. It highlights endoscopy's ability to manage infections with less morbidity compared to open surgery. The combination of a systematic review and a case series strengthens the relevance of the findings. Spinal infections pose significant challenges in management due to their complexity and potential for complications. Traditional open surgeries, while effective, are associated with greater surgical trauma. This study addresses the gap by evaluating a less invasive option, showcasing its efficacy and safety. The findings align with existing literature, which supports the use of minimally invasive techniques for faster recovery and fewer complications. However, this study uniquely combines a systematic review with real-world case analyses, providing a comprehensive perspective on clinical applicability. Further research should focus on standardizing protocols for pathogen identification to improve diagnostic accuracy; conducting randomized controlled trials to compare long-term outcomes between endoscopic and traditional techniques; and evaluating the learning curve for surgeons adopting this method and its impact on outcomes, including diverse patient populations to validate results across varied clinical scenarios. Figure 10: Pre-operative T2 sagittal MRI. The management of spinal infections, including primary infections such as spondylolosicitis and secondary, iatrogenic post-operative infections, remains a complex and contentious issue in the clinical field [21; 32]. Despite significant advancements in both diagnostic and therapeutic modalities, there is still no universally accepted guideline that delineates the optimal approach to treatment. Clinicians must often choose between conservative management, involving empirical or targeted antibiotic therapy, and surgical intervention, which can range from simple debridement to more complex procedures involving spinal stabilization [33]. Each of these treatment pathways comes with its own set of potential benefits and drawbacks, making the decision-making process highly individualized and dependent on patient-specific factors. Conservative treatment, which typically involves bed rest, immobilization, and prolonged antibiotic therapy, has been the cornerstone of managing spondylolosicitis for decades [34]. However, this approach, while avoiding surgical risks, is associated with prolonged hospital stays, the need for immobilization, and often significant residual pain. Success rates of conservative treatment hover around 75-80%, as reported in various studies, with approximately 20-25% of patients ultimately requiring surgical intervention due to persistent or worsening symptoms, especially in cases involving neurological deficits [34]. Surgical intervention is generally reserved for those cases where conservative measures fail or when a rapid deterioration in neurological status occurs.