Strategies to Reduce Rebound Pain and Facilitate Early Recovery After Transforaminal Endoscopic Lumbar Discectomy

Abstract

Background: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive and popular surgical method for the treatment of lumbar disc herniation. Although TELD offers favourable outcomes and enables fast recovery, some patients experience rebound pain and transient postoperative pain, which can delay rehabilitation and decrease patient satisfaction. Methods: This narrative review was conducted based on a comprehensive literature search of the MEDLINE database, supplemented by the author's clinical experience. Relevant articles were identified using the keywords "rebound pain" and "transforaminal endoscopic lumbar discectomy" or "percutaneous endoscopic lumbar discectomy". A thorough examination of rebound pain after TELD was performed by reviewing what has currently been published about its clinical traits. It was also compared with what could be observed in open lumbar discectomy and proposed preventive measures. Results: Rebound pain typically occurs within 2 weeks postoperatively and resolves spontaneously within 3 weeks. The proposed pathologies include inflammatory edema, transient ischemia, neural hypersensitivity, and increased pressure inside the disc. Risk factors include early unreasonable activity, incomplete release, and psychological predispositions. Rebound pain must be distinguished from recurrent herniation. Prevention strategies include adequate decompression, minimal neural irritation, postoperative medications, and early mobilization protocols. Conclusions: Rebound pain after TELD is self-limiting but has a clinical effect that may delay timely rehabilitation and raise concerns for surgeons and patients. Awareness and early recognition can enhance postoperative care and optimize clinical outcomes after TELD.

Keywords: discectomy; endoscopy; lumbar vertebrae; minimally invasive surgical procedures; postoperative pain; recurrence.

Figure 1

The clinical characteristics of rebound pain following transforaminal endoscopic lumbar discectomy (TELD). Rebound pain is defined as a transient recurrence of leg pain, with or without back pain, following initial postoperative improvement after TELD. Typically occurring within 2 weeks after surgery, the pain is milder than the preoperative level and resolves spontaneously within 3 weeks.

Figure 2

The proposed pathogenesis of rebound pain after transforaminal endoscopic lumbar discectomy (TELD). (A) A herniated lumbar disc causing severe radiculopathy by compressing the dural sac and nerve root. (B) Immediate postoperative status after a successful TELD. The herniated disc was selectively removed, and neural decompression was achieved. (C) The development of rebound pain is multifactorial. Despite successful decompression, inflammatory edema around the nerve root, ischemia–reperfusion injury, neural hypersensitivity, and increased intradiscal pressure contribute to transient symptom exacerbation.

Figure 3

A comparison of surgical principles between transforaminal endoscopic lumbar discectomy (TELD) and open lumbar discectomy. (A) TELD involves limited disc removal without laminectomy and preserves the central nucleus, which may retain the intradiscal pressure (arrows). This may lead to transient neural irritation during the recovery period. (B) In contrast, open discectomy typically involves more radical disc removal with posterior decompression (e.g., laminectomy), which creates a greater space for postoperative edema and reduced residual pressure (arrows).