Ultra-minimally invasive endoscopic spine surgery advanced significantly in 2024. Emory University Hospital Midtown became Georgia’s first academic medical center to offer ultra-minimally invasive (UMI) endoscopic procedures using small cameras and tools through incisions as small as a pencil tip to treat herniated discs and other spine conditions. Patients can walk out the same day and return to work within a week, compared to traditional open surgery requiring overnight stays. Research demonstrated that endoscopic spine surgery reduces opioid use by 21 percent compared to other minimally invasive techniques. Biportal endoscopic techniques, TLIF procedures, and dualPortal 2.0 technology have expanded surgeon capabilities. Advanced 4K camera visualization allows surgeons to visualize around and underneath nerve roots in ways previously impossible. Procedures typically take 45 minutes to an hour versus 90 minutes for traditional surgery. Major symposiums with cadaver workshops train surgeons in these techniques.