Related Experiment Video
Updated: Jul 6, 2026
A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
Transforaminal endoscopic lumbar discectomy versus interlaminar endoscopic lumbar discectomy for lumbar disc
Paula K Krause1, Jannik Leyendecker2, Cathryn Payne1
1Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
Background Context:
Full-endoscopic lumbar discectomy can be performed via transforaminal (TELD) or interlaminar (IELD) routes, yet comparative evidence on early recovery trajectories remains limited.
Purpose:
To evaluate postoperative pain and disability patterns after TELD and IELD and identify approach-specific recovery characteristics and predictors.
Study Design/Setting:
Prospective multicenter cohort study.
Patient Sample:
A total of 573 patients undergoing ambulatory full-endoscopic lumbar discectomy (351 TELD, 222 IELD).
Outcome Measures:
VAS back pain, ipsilateral leg pain, and Oswestry Disability Index (ODI).
Methods:
Patient-reported outcomes were collected via the SpineHealthie platform daily during week 1 and at 2 weeks, 1, 3, 6, and 12 months. Linear mixed-effects ANCOVA models adjusted for baseline patient-reported outcome measures, age, body mass index, disc morphology, and L5/S1-level were used to compare trajectories.
Results:
Both techniques yielded rapid, durable reductions in pain and disability. IELD demonstrated faster and more pronounced early recovery. Adjusted mean differences favored IELD at 2 weeks for back pain (-0.77; p=.014) and ODI (-2.50; p=.042), peaking at 6 months (back pain -1.27; ODI -6.14; both p<.001). Differences converged by 12 months for ODI. Surgical approach accounted for 2%-3% of variance (η²=0.02-0.03), while disc morphology (η²=0.04) and body mass index (η²=0.06) emerged as independent predictors. Age had no effect.
Conclusions:
TELD and IELD are safe, effective techniques. IELD enables faster recovery and greater short-term functional improvement, whereas TELD provides durable long-term benefit, especially for foraminal and upper lumbar pathology. Outcomes depend on surgical exposure, disc morphology, and body habitus, supporting an anatomy-guided, individualized approach.
