Currently, the diagnosis of persistent pain conditions of the spine is by no means standardised, and there has been a lack of clear consensus regarding appropriate algorithms both for diagnosis and for treatment. One needs only to recall the case of discography, which was recognised as having diagnostic value but of uncertain applicability in routine clinical practice. An important component of diagnosis and treatment of chronic spinal pain is the procedure of spinal endoscopy, a minimally invasive endoscopic technique recently introduced for use in clinical practice. It can be expected that the specific roles of this spinal endoscopy will be defined relative to other invasive and non-invasive therapeutic procedures, and its cost-benefit ratio will be assessed to better characterise areas of application. The challenge for its clinical acceptance is to provide the medical evidence showing that consistent results are obtained when clinicians performing this procedure have appropriate educational training and accreditation, and use standardised quality instrumentation as part of defined protocols.