Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope and Limitations

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity. OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence. METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied to identify potential bias between neurosurgeons and orthopedic surgeons and to explore associations between pathologies. RESULTS: = -0.317). CONCLUSION: These findings suggest that technical proficiency in 1 domain does not necessarily translate to others, emphasizing the need for specialized training in complex or atypical scenarios. Refinement in training and technique positions transforaminal endoscopic surgery to redefine spinal stenosis care, moving past the entrenched notion that its use is confined to foraminal and lateral canal disease while central canal pathology belongs exclusively to interlaminar methods. CLINICAL RELEVANCE: This study signals a shift away from the rigid notion that transforaminal endoscopy is limited to compressive painful pathology in the lateral canal while interlaminar approaches are preferable for central stenosis. In expert hands, modern endoscopic techniques demonstrate that low-risk transforaminal decompression can be successfully applied to more complex conditions, including central stenosis with or without low-grade spondylolisthesis. These findings emphasize the importance of advanced training programs to enable practicing spine surgeons to achieve outcomes comparable to those reported by key opinion leaders. LEVEL OF EVIDENCE: Psychometrically validated, high-quality observational survey study (see also Authors' Note).