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Updated: May 13, 2026

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Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope and Limitations.

Kai-Uwe Lewandrowski1,2,3,4, Álvaro Dowling5,6, Jun Ho Lee7

  • 1Division Personalized Pain Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA business@tucsonspine.com.

International Journal of Spine Surgery
|May 11, 2026
PubMed

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Summary
This summary is machine-generated.

Surgeon confidence varies for transforaminal endoscopic lumbar decompression (TELD) across different spinal conditions. While TELD is favored for herniated nucleus pulposus (HNP) and lateral stenosis, its use for facet cysts and spondylolisthesis is debated, highlighting training needs.

Area of Science:

  • Minimally invasive spine surgery
  • Spinal endoscopy techniques
  • Surgical consensus and training

Background:

  • Transforaminal endoscopic lumbar decompression (TELD) offers a minimally invasive approach for lumbar stenosis and disc herniations.
  • Despite reported favorable outcomes, TELD adoption varies due to surgeon experience and case complexity.
  • Understanding surgeon perspectives is crucial for broader clinical application.

Purpose of the Study:

  • To assess spine surgeons' views on TELD's applicability across various spinal pathologies.
  • To compare surgeon perspectives with existing scientific evidence on TELD outcomes.
  • To identify areas of consensus and controversy regarding TELD use.

Main Methods:

  • An international survey of spine surgeons was conducted.
Keywords:
TELD efficacycentral canal stenosisforaminal stenosislateral canal stenosislumbar herniationminimally invasive surgerypatient recoveryspinal stenosisspine surgery techniquessurgical visualizationtransforaminal endoscopic lumbar decompression

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  • Rasch modeling analyzed surgeon responses to determine consensus levels.
  • Differential Item Functioning (DIF) and correlation analyses explored potential biases and pathology associations.

    • Main Results:

    • Strong consensus for TELD in posterolateral HNP, far-migrated HNP, and lateral canal stenosis.
    • Moderate consensus for central HNP and central canal stenosis, with some variability.
    • Low agreement for lumbar facet cysts and low-grade spondylolisthesis, indicating divergent practices.
    • Correlation analysis revealed distinct domains of surgical confidence, with negative associations between certain pathologies.

    Conclusions:

    • Technical proficiency in one TELD application does not guarantee success in others, necessitating specialized training.
    • Transforaminal endoscopic surgery can be refined for complex conditions beyond lateral disease, challenging traditional indications.
    • Advanced training is essential for surgeons to achieve expert-level outcomes with TELD in diverse spinal pathologies.