Spondylodiscitis is a serious spinal infection that can cause spinal instability, neurologic deficits, and paralysis. Although endoscopic procedures are becoming increasingly common, their role in spondylodiscitis management remains undefined. In this systematic review, PubMed, Embase, and MEDLINE were searched for studies published from January 1950 to March 2024 on percutaneous endoscopic debridement and drainage (PEDD) surgery for spondylodiscitis. The inclusion criteria included clinical trials or case series of spondylodiscitis patients treated with endoscopy. Primary outcomes included culture yield, complications, reoperations, treatment success rates, and pain scores. Our review included 40 studies that assessed 667 patients. Most studies presented low-level evidence, consisting of case reports (40.0%) and case series (60.0%). Endoscopic techniques demonstrated a positive culture yield of 67.3%, with an overall complication rate of 7.8% (95% confidence interval [CI], 5.35%–10.47%) and a reoperation rate of 13.1% (95% CI, 10.08%–16.31%). There were no complications related to cerebrospinal fluid leaks or meningitis. The medical treatment success rate was higher in patients who underwent concurrent instrumentation than in those who received endoscopic debridement alone (96.4% vs. 85.9%, p=0.003). Thirteen studies presented patient-reported pain outcomes, and all cohorts showed improvements. This review suggests that PEDD shows promise as a safe and effective adjunctive treatment for spondylodiscitis, offering low complication rates and successful treatment. PEDD may play a role within a multidisciplinary treatment approach. Future clinical trials are needed to determine whether early PEDD can improve the overall success of medical therapy and reduce the need for more extensive debridement and fusion surgery.