BACKGROUND: Lumbar spinal endoscopy has long been mischaracterized by payers as investigational. Such claims conflict with decades of refinement, randomized trials, and policy precedent. METHODS: We reviewed the historical evolution, prospective trials, meta-analyses, and policy milestones of transforaminal endoscopic lumbar discectomy (TELD), with emphasis on coding, reimbursement, and comparative effectiveness. RESULTS: Evidence demonstrates that TELD, performed with direct visualization, provides durable outcomes with complication, reoperation, and conversion rates equal or superior to open decompression. Meta-analyses confirm comparable effect sizes to microsurgery, while selective integration with motion-preserving adjuncts extends durability in complex cases. CONCLUSION: TELD has matured into a safe and durable technology. It is not limited to lateral recess disease but is capable of effectively addressing central stenosis, including select cases with low-grade spondylolisthesis. TELD's trajectory mirrors that of other coverage-adopted technologies, and its future impact depends on structured training to ensure reproducibility and broad patient access. CLINICAL RELEVANCE: This work establishes that transforaminal endoscopy, performed with direct visualization, is not limited to lateral recess disease. TELD can safely and effectively address central stenosis, including selected cases with low-grade spondylolisthesis. Contemporary evidence demonstrates durable outcomes comparable to open decompression. The next step is structured training to ensure reproducibility across the broader surgical community, thereby securing patient access to this established and codified technique within recognized coverage frameworks.
Lorio et al. (Wed,) studied this question.