BackgroundTravel distance can serve as an objective, behavioral measure of patient preference in health care. Endoscopic spine surgery is the least invasive surgical option for treating spinal pathology, yet access is limited due to the relatively small number of trained surgeons. This study evaluates travel patterns of patients seeking care at the Endoscopic Spine Institute of New York, a specialized center staffed by 3 fellowship-trained endoscopic spine surgeons.MethodsWe conducted a retrospective analysis of the first 100 consecutive patients undergoing endoscopic spine surgery at Endoscopic Spine Institute of New York. The primary objective was to quantify patient travel distance as a behavioral proxy for preference for specialized, minimally invasive care. Secondary objectives were to characterize spinal pathology, determine revision surgery frequency, and compare travel distances by pathology type and revision status. Travel distances were calculated as straight-line distances from the patient’s city of residence to the institute. Descriptive and comparative statistics were performed.ResultsThe mean travel distance was 308.4 miles (SD: 494.1), with patients traveling from multiple states and internationally. Surgical interventions included cervical (20%), thoracic (18%), and lumbar (62%) pathologies. Revision surgeries accounted for 29% of cases. Travel distance was significantly greater for revision cases compared with primary cases (P < 0.05). Lumbar pathology cases were associated with slightly longer travel distances compared with cervical and thoracic cases, though differences were not statistically significant.ConclusionsPatients are willing to travel substantial distances to access specialized, minimally invasive spine surgery. Travel distance serves as a behavioral measure of patient preference, distinct from conventional quality metrics, providing insight into patient priorities in health care utilization and informing the centralization of specializ