A published review and international survey on endoscopic lumbar disc surgery

A review by Dr. Siravich Suvithayasiri and his co-authors was published in the journal Neurospine (Q1) on 31 October 2026. Dr. Siravich Suvithayasiri is the paper's first author. It is about transforaminal endoscopic lumbar discectomy (TELD) — keyhole surgery done through a small channel at the side of the spine, to take out the part of a lumbar disc that is pressing on a nerve.

The question the paper asked

TELD is performed by 2 techniques that differ in where the working corridor is established at the start of the operation. In the inside-out technique the instruments dock within the disc and work outward. In the outside-in technique the corridor is established in the foramen — the bony opening the nerve leaves through — usually by foraminoplasty, and the disc is entered as the last step. The paper took the arguments made for each technique and checked them against what the published literature actually shows, and then described current opinion in practice.

How it was done

The paper has 2 parts. Part 1 was a narrative, nonsystematic structured debate across 7 domains, with one author arguing each position and a joint reconciliation then assigning a verdict in each domain from a taxonomy fixed in advance. Part 2 was a single-round structured international opinion survey of 78 endoscopic spine surgeons from 23 countries, analysed against an agreement threshold set before the survey ran.

What it found

The 7 domains produced 8 verdicts, because clinical outcomes were judged separately at short term and at long term. 2 domains resolved as mixed, 2 as context-dependent, 1 as conditional on the patient's phenotype, and 3 were left unresolved because the comparative studies that would settle them do not exist. In the survey, 10 statements reached the agreement threshold. The paper notes that the panel was imbalanced: most of the surgeons who answered practise predominantly outside-in.

What the authors conclude

Current evidence does not support a general recommendation for either technique, and the survey describes the preferences of a predominantly outside-in panel rather than settling the question. The choice, the authors write, should follow the pathology, the anatomy of the foramen, and the operating surgeon's own experience and familiarity.

For a reader outside the field, that is the part worth keeping: the route an endoscopic spine operation takes is a case-by-case decision, matched to the condition and to the anatomy of the person being operated on.