Interlaminar Versus Transforaminal Full-Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Structured Debate and International Practice Patterns

Abstract

Objective: This study aimed to synthesize evidence comparing transforaminal (TELD) and interlaminar (IELD) full-endoscopic lumbar discectomy and characterize surgeons’ stated approach preferences across anatomical scenarios.Methods: We conducted a structured narrative (nonsystematic) synthesis across 7 domains using PubMed/MEDLINE, Embase, and Scopus through July 2026. Pro-TELD and pro-IELD advocacy drafts were prepared independently; the corresponding author adjudicated domain-level verdicts without drafting either perspective. An international cross-sectional survey used convenience and snowball sampling to assess 172 spine surgeons’ preferences across 25 scenarios developed independently of the Kotheeranurak et al. algorithm; survey findings were subsequently compared with the algorithm. Consensus was predefined as ≥ 70% agreement; experience-based analyses were exploratory.Results: The evidence showed no universal superiority. Short- and intermediate-term clinical outcomes were largely convergent, long-term comparative outcomes remained unresolved, complication profiles were partially resolved, and cost-effectiveness was context-dependent. Twelve of 25 survey scenarios reached consensus. Survey preferences were concordant with the Kotheeranurak et al. benchmark algorithm in 6 of 9 compared scenario groups; 1 was discordant and 2 remained below the consensus threshold. TELD was favored for selected foraminal/extraforaminal lesions (up to 91.3%) and directionally preferred at upper-lumbar levels, whereas IELD was favored for central/paracentral L5–S1 disease (88.4%) and selected migrated lesions. Thirteen scenarios, predominantly involving transitional levels and complex calcified or migrated pathology, did not reach consensus. Experience-related patterns were exploratory and did not consistently favor either corridor.Conclusion: TELD and IELD are complementary corridors. Selection should reflect lesion anatomy, pathology, surgeon expertise, and healthcare context rather than presumed overall superiority.

The authors' abstract, as published at the source. Neurospine, 2026 · DOI ↗