Transforaminal endoscopic lumbar discectomy (TELD) is increasingly used as an effective alternative to open discectomy or microdiscectomy, supported by comparable outcomes in the literature. Advances in techniques and instrumentation now permit selective endoscopic decompression of diverse disc pathologies, including complex stenosis cases. However, the rising number of procedures has been accompanied by a corresponding increase in complications, which has been exacerbated by heterogeneous reporting standards in literature. Standardized systems for defining, classifying, and scoring TELD complications are lacking, but would be essential for quality assurance, comparative studies, research, and outcome assessment. Therefore, we systematically reviewed the literature to identify studies focusing on TELD complications and propose a consensus classification system. PubMed, Scopus, and Science Direct were searched to identify studies primarily addressing complications, or their classification, in patients with lumbar disc herniation or lumbar canal stenosis undergoing TELD. The exclusion criteria encompassed studies involving other pathologies, such as infections or tumors, and studies with patients undergoing revision surgery. Initial database searches yielded 887 articles, with 560 unique articles after duplicate removal. Title and abstract screening excluded 313 articles, leaving 247 articles for full-text assessment. Ultimately, 95 articles met the inclusion criteria. The narrative synthesis focused on compiling complications associated with TELD, which helped propose a structured classification system. Complications in TELD can match or exceed those of traditional surgical procedures, influenced by a steep learning curve and longer initial operation times. Expanded indications introduce the potential for encountering previously unreported complications even among experienced surgeons. Effective documentation, rating, and follow-up of complications are crucial for informed treatment decisions, enhancing patient consent processes, and improving overall outcomes.

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92–1.04; p =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, p =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.