Full-endoscopic lumbar spine discectomy: in search of the optimal approach—a meta-analysis comparing interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD)

This meta-analysis aimed to compare the clinical effectiveness and safety of interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) for symptomatic lumbar disc herniation, and to identify factors that guide the selection of the optimal surgical approach. A comprehensive systematic review was performed by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials and cohort studies published from 2013 to 2024. The inclusion criteria encompassed studies comparing interlaminar endoscopic lumbar discectomy and transforaminal endoscopic lumbar discectomy in adult patients aged 18 years and older. Primary clinical outcomes evaluated included operative duration, radiation exposure, postoperative pain measured by the visual analog scale (VAS) for back and leg pain, functional disability assessed via the Oswestry Disability Index (ODI), complication rates, reoperation rates, and length of hospital stay. Data synthesis was conducted using a random-effects model, with subgroup analyses stratified by operative spinal level and study design. A total of 17 studies involving 2,066 patients (TELD = 1,040; IELD = 1,026) met the inclusion criteria. TELD was associated with faster recovery and earlier mobilization, particularly in randomized studies. IELD was linked to shorter operative times and significantly lower radiation exposure, whereas TELD tended to result in reduced postoperative back pain, likely due to better preservation of anatomical structures. No significant differences were observed in complication or recurrence rates between the two approaches. However, substantial heterogeneity across studies limited the generalizability of these findings. Both TELD and IELD are effective and safe surgical options for the treatment of lumbar disc herniation, each offering distinct advantages in operative parameters and clinical outcomes. Current evidence does not conclusively favor one approach over the other. A major limitation in drawing definitive comparisons is the scarcity of large-scale, high-quality randomized controlled trials involving homogeneous patient populations.