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.

Methods: The study comprised 62 subjects. Of this number, 32 subjects (group A) were unskilled laborers from the construction industry; the other 30 subjects (group B) were in the control group and had never previously carried heavy weights on their heads. Cervical spine radiographs were taken for all the 62 subjects. Subjects in group A were asked to carry a load (approximately 35 kg) on their heads and walk for about 65 m, with their cervical spine radiographs taken afterward. Results: The mean ages of patients in groups A and B were 27.17 and 25.75 years, respectively. The mean cervical lordosis observed in group A (18.96°) was dramatically less compared with group B (25.40°), showing a further decrease in head loading (3.35°). Five subjects had a reversal of lordosis (−5.61°). A statistically significant reduction in disc height and listhesis was observed when the load was carried on the head with a further decrease after walking with the load. Accelerated degenerative changes, particularly affecting the upper cervical spine, were observed in head loaders. Conclusions Carrying a load on the head leads to accelerated degenerative changes, which involve the upper cervical spine more than the lower cervical spine and predisposes it to injury at a lower threshold. Thus, alternative methods of carrying loads should be proposed.

We aim to present the current evidence on various risk factors and surgical treatment modalities for recurrent lumbar disc herniation (rLDH). Using PubMed, a literature search was performed using the Mesh terms “recurrent disc prolapse,” “herniated lumbar disc,” “risk factors,” and “treatment.” Articles that were published between January 2010 and May 2017 were selected for further screening. A search conducted through PubMed identified 213 articles that met the initial screening criteria. Detailed analyses showed that 34 articles were eligible for inclusion in this review. Sixteen articles reported the risk factors associated with rLDH. Decompression alone as a treatment option was studied in seven articles, while 11 articles focused on different types of fusion surgery (anterior lumbar interbody fusion, posterior lumbar interbody fusion, open transforaminal lumbar interbody fusion [TLIF], and minimally invasive surgery-TLIF). Management of the rLDH requires consideration of the possible risk factors present in individual patients before primary and at the time of second surgery. Both, minimally invasive and conventional open procedures are comparably effective in relieving leg pain, and minimally invasive techniques offer advantage over the other technique in terms of tissue sparing. Non-fusion surgeries involve the risk of lumbar disc herniation re-recurrence, and the patient may require a third (fusion) surgery.