Full-Endoscopic Lumbar Discectomy: A Review of the Surgical Techniques, Indications and Anatomical Considerations

Full-endoscopic lumbar discectomy (FELD) has emerged over time as a minimally invasive alternative to conventional microdiscectomy. This narrative review summarizes the available evidence regarding the evolution, indications, techniques, and outcomes of FELD, with a particular focus on how different types of lumbar disc herniations influence the choice of surgical approach. The literature indicates that the transforaminal approach is most suitable for foraminal and upper lumbar disc herniations, whereas the interlaminar approach is preferred for central or migrated L5-S1 herniations due to the larger interlaminar window at this level. Unilateral biportal endoscopy (UBE) provides better flexibility, visualization, and instrument maneuverability, making it particularly useful in certain cases. Reported complication rates remain low overall but vary according to surgical technique and surgeon experience. The learning curve for FELD typically ranges from approximately 20 to over 50 cases, depending on the approach and individual proficiency. Overall, full-endoscopic techniques are redefining the management of lumbar disc herniations by offering less invasive alternatives with favourable clinical outcomes, and their role is expected to expand further as both technology and surgical expertise continue to evolve.