Transforaminal endoscopic lumbar discectomy

Transforaminal endoscopic lumbar discectomy (TELD) is an emerging alternative to open microdiscectomy for lumbar disc herniation (LDH). The published results of TELD are not inferior to those of the standard surgery. Because of the learning curve and unique adverse events associated with TELD, surgeons should overcome the technical hurdles of different cases in actual practice. However, practical guidelines for the TELD technique in various situations are lacking. This article aimed to provide technical tips and tricks to achieve a relevant and reliable outcome, avoiding complications in all kinds of LDH cases. A narrative review of the literature was conducted on the basic principles, endoscopy-specific complications, and advanced techniques of the full-endoscopic procedure depending on different categories of LDH: contained, extruded, migrated, and recurrent LDH at different disc levels and zones. The principles of TELD technique are applicable to every type of LDH. First, the access angle and landing point should be nearest to the disc pathology and should be modified according to the situation of each case. Second, fibrotic annular anchorage should be sufficiently released before removing the offending fragments. Third, the surgical endpoint can be declared by the strong pulsation of the dural sac and free mobilization of the nerve root. Lastly, surgeons should always identify the anatomical distinction between the neural tissues, herniated discs, and surrounding soft tissues to ensure clinical success. In conclusion, owing to the recent technical evolution, TELD can be applied to almost all types of LDH.