Transforaminal Endoscopic Lumbar Discectomy: Basic Concepts and Technical Keys to Clinical Success

Abstract

Background: Open microdiscectomy is the gold standard surgical technique for radiculopathy with lumbar disc herniation (LDH). Transforaminal endoscopic lumbar discectomy (TELD) has been developed as an effective and minimally invasive alternative to open surgery. As a result of these remarkable technical evolutions, the clinical outcomes of TELD have become comparable to those of conventional open surgery. However, considerable learning curves and endoscopy--related adverse events may emerge as critical problems. Objective: The objective of this article was to inform on the basic principles, surgical techniques, and keys to clinical success in preventing complications. Methods: A narrative review of the literature focused on the surgical indications, technical tips, complications, and learning curve of the full-endoscopic procedure was performed. Results: First, the transforaminal endoscopic system should access as close as possible to the target point, avoiding exiting nerve root irritation. Second, selective removal of the herniated disc fragments after sufficiently releasing the annular anchorage parts is essential to avoid incomplete decompression or prevent an early recurrence. Third, the endpoint of the procedure can be determined at the point of solid pulsation and free mobilization of the nerve root. Finally, surgeons should always ensure that the anatomical layers discriminate the neural tissue and disc material during the procedure. Some authors have demonstrated the effectiveness of TELD through randomized controlled trials, meta-analyses, and systemic reviews. According to these studies, the clinical outcomes of TELD are not inferior to those of open discectomy, with an earlier recovery period and fewer complications. Conclusions: The full-endoscopic transforaminal discectomy technique for soft LDH is an effective alternative with the benefits of minimally invasive surgery in appropriately selected patients. Given recent technical developments, the surgical indications for TELD will be broader and the clinical outcomes will be more reliable.