Full-endoscopic spine surgery is advancing rapidly. Although acceptance was initially low, numerous high-quality studies have demonstrated the non-inferiority—and in some cases, superiority—of full-endoscopic spinal decompression compared to traditional techniques, fostering greater adoption of this ultra-minimally invasive approach. While procedures to address degenerative spine diseases are well established, there has been little focus on full-endoscopic treatment of extra−/intradural tumors, infections, tethered cord syndrome, and intradural cysts. The minimum requirement for employing full-endoscopic techniques for spinal tumor removal and abscess drainage should be non-inferiority compared to the gold standards of open and microsurgery. However, achieving non-inferiority is hindered by several factors, primarily the lack of specialized instruments. The industry has primarily focused on developing tools for degenerative conditions, neglecting the equipment needed for endoscopically treating extra−/intradural lesions and lumbar spinal infections. Essential instruments, such as dural scalpels, retraction devices, extendable sharp dissectors, suitable scissors, closure devices, and specific probes, are currently unavailable. Furthermore, studies indicate that durotomy and prolonged endoscopic procedures are risk factors for severe complications, including neck pain, headaches, seizures, and visual disturbances. These risks are particularly relevant during intradural procedures, such as removing mass lesions or untethering a cord. Even if the intradural pathology can be addressed, the question remains regarding the necessity and methods for effective dural closure.