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Percutaneous endoscopic spine surgery differs from other minimally invasive spinal techniques because of use of the spinal endoscope. With the development and improvement of endoscopic optical technology, endoscopic surgical techniques and instrumentation, central, paracentral, foraminal and far lateral lumbar disc herniation can now be treated by endoscopic techniques. Endoscopic systems are also used for posterior interlaminar lumbar decompression, anterior and posterior cervical discectomy. Some unilevel lumbar stenosis may be treated by the endoscopic techniques as well. Although the surgical indications for endoscopic techniques are evolving, there are many potential complications, such as nerve root injury, durotomy, infection, retro-peritoneal cavity injury, cauda equine injury, great vessel injury, muscular hematoma, re-herniation, piriformis syndrome, and/or epidural hematoma. So, the endoscopic spine surgery can only be practiced after the completion of learning curve which could be improved through training, mentorship and clinic surgical experience. Surgical training, including didactic lectures, hands on cadaveric training, and surgical observation, should all be essential for surgical education and instruction. Appropriate preoperative planning and strictly controlled indications of percutaneous endoscopic spine surgery are necessary and important for optimal outcomes.