Interlaminar Versus Transforaminal Full-Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Structured Debate and International Practice Patterns

Objective: This study aimed to synthesize evidence comparing transforaminal (TELD) and interlaminar (IELD) full-endoscopic lumbar discectomy and characterize surgeons’ stated approach preferences across anatomical scenarios.Methods: We conducted a structured narrative (nonsystematic) synthesis across 7 domains using PubMed/MEDLINE, Embase, and Scopus through July 2026. Pro-TELD and pro-IELD advocacy drafts were prepared independently; the corresponding author adjudicated domain-level verdicts without drafting either perspective. An international cross-sectional survey used convenience and snowball sampling to assess 172 spine surgeons’ preferences across 25 scenarios developed independently of the Kotheeranurak et al. algorithm; survey findings were subsequently compared with the algorithm. Consensus was predefined as ≥ 70% agreement; experience-based analyses were exploratory.Results: The evidence showed no universal superiority. Short- and intermediate-term clinical outcomes were largely convergent, long-term comparative outcomes remained unresolved, complication profiles were partially resolved, and cost-effectiveness was context-dependent. Twelve of 25 survey scenarios reached consensus. Survey preferences were concordant with the Kotheeranurak et al. benchmark algorithm in 6 of 9 compared scenario groups; 1 was discordant and 2 remained below the consensus threshold. TELD was favored for selected foraminal/extraforaminal lesions (up to 91.3%) and directionally preferred at upper-lumbar levels, whereas IELD was favored for central/paracentral L5–S1 disease (88.4%) and selected migrated lesions. Thirteen scenarios, predominantly involving transitional levels and complex calcified or migrated pathology, did not reach consensus. Experience-related patterns were exploratory and did not consistently favor either corridor.Conclusion: TELD and IELD are complementary corridors. Selection should reflect lesion anatomy, pathology, surgeon expertise, and healthcare context rather than presumed overall superiority.