{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:10:41Z","timestamp":1789611041745,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,18]],"date-time":"2025-05-18T00:00:00Z","timestamp":1747526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2019s clinical experience. Relevant articles were identified using the keywords \u201crebound pain\u201d and \u201ctransforaminal endoscopic lumbar discectomy\u201d or \u201cpercutaneous endoscopic lumbar discectomy\u201d. 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.<\/jats:p>","DOI":"10.3390\/jcm14103529","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T06:31:29Z","timestamp":1747636289000},"page":"3529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Strategies to Reduce Rebound Pain and Facilitate Early Recovery After Transforaminal Endoscopic Lumbar Discectomy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-1672","authenticated-orcid":false,"given":"Yong","family":"Ahn","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.joca.2012.06.018","article-title":"Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: The Wakayama Spine Study","volume":"20","author":"Ishimoto","year":"2012","journal-title":"Osteoarthr. Cartil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"56","DOI":"10.14245\/ns.2346226.113","article-title":"Complications and management of endoscopic spinal surgery","volume":"20","author":"Ju","year":"2023","journal-title":"Neurospine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/BF00258242","article-title":"Percutaneous endoscopic lumbar discectomy (PELD)","volume":"16","author":"Mayer","year":"1993","journal-title":"Neurosurg. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/00003086-199802000-00018","article-title":"Arthroscopic microdiscectomy and selective fragmentectomy","volume":"347","author":"Kambin","year":"1998","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/00007632-200204010-00009","article-title":"Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases","volume":"27","author":"Yeung","year":"2002","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"476","DOI":"10.3171\/2008.7.17634","article-title":"Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: A prospective, randomized, controlled study","volume":"10","author":"Ruetten","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1227\/NEU.0000000000000361","article-title":"Percutaneous endoscopic lumbar foraminotomy: An advanced surgical technique and clinical outcomes","volume":"75","author":"Ahn","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00003086-198606000-00008","article-title":"Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results","volume":"207","author":"Kambin","year":"1986","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00003086-198901000-00003","article-title":"Percutaneous nucleotomy. A new concept technique and 12 years\u2019 experience","volume":"238","author":"Hijikata","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"958","DOI":"10.2106\/00004623-199907000-00008","article-title":"A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy","volume":"81","author":"Hermantin","year":"1999","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E890","DOI":"10.1097\/01.brs.0000245955.22358.3a","article-title":"Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: A prospective randomized study in 280 consecutive cases","volume":"31","author":"Hoogland","year":"2006","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3171\/jns.1993.78.2.0216","article-title":"Percutaneous endoscopic discectomy: Surgical technique and preliminary results compared to microsurgical discectomy","volume":"78","author":"Mayer","year":"1993","journal-title":"J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1097\/BRS.0b013e31816c8af7","article-title":"Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: A prospective, randomized, controlled study","volume":"33","author":"Ruetten","year":"2008","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/BSD.0b013e318175ddb4","article-title":"Recurrent lumbar disc herniation after conventional discectomy: A prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision","volume":"22","author":"Ruetten","year":"2009","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"72","DOI":"10.14444\/7010","article-title":"Percutaneous endoscopic lumbar discectomy versus microdiscectomy for the treatment of lumbar disc herniation: Pain, disability, and complication rate\u2014A randomized clinical trial","volume":"14","author":"Meyer","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00586-016-4885-6","article-title":"A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy","volume":"26","author":"Gibson","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s00586-009-1155-x","article-title":"Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: A systematic review of the literature","volume":"19","author":"Nellensteijn","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s00586-015-3776-6","article-title":"A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation","volume":"25","author":"Cong","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_19","first-page":"103","article-title":"Full-Endoscopic procedures versus traditional discectomy surgery for discectomy: A systematic review and meta-analysis of current global clinical trials","volume":"19","author":"Li","year":"2016","journal-title":"Pain Physician"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ijsu.2016.05.061","article-title":"Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: A meta-analysis","volume":"31","author":"Ruan","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1007\/s00132-018-3528-5","article-title":"Meta-analysis of percutaneous transforaminal endoscopic discectomy vs. fenestration discectomy in the treatment of lumbar disc herniation","volume":"47","author":"Ding","year":"2018","journal-title":"Orthopade"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s13018-018-0868-0","article-title":"Transforaminal endoscopic discectomy versus conventional microdiscectomy for lumbar discherniation: A systematic review and meta-analysis","volume":"13","author":"Zhang","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"802","DOI":"10.3171\/2019.6.SPINE19532","article-title":"Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: A meta-analysis","volume":"31","author":"Barber","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/BRS.0000000000003843","article-title":"Percutaneous transforaminal endoscopic discectomy versus open microdiscectomy for lumbar disc herniation: A systematic review and meta-analysis","volume":"46","author":"Gadjradj","year":"2021","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1177\/21925682211020696","article-title":"Comparison of endoscopic discectomy versus non-endoscopic discectomy for symptomatic lumbar disc herniation: A systematic review and meta-analysis","volume":"12","author":"Li","year":"2022","journal-title":"Global Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S1529-9430(01)00153-X","article-title":"Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: Outcome and technique","volume":"2","author":"Tsou","year":"2002","journal-title":"Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"335","DOI":"10.36076\/ppj.2013\/16\/335","article-title":"The current state of endoscopic disc surgery: Review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures","volume":"16","author":"Birkenmaier","year":"2013","journal-title":"Pain Physician"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"295","DOI":"10.36076\/ppj\/2019.22.295","article-title":"Transforaminal endoscopic lumbar discectomy versus open lumbar microdiscectomy: A comparative cohort study with a 5-year follow-up","volume":"22","author":"Ahn","year":"2019","journal-title":"Pain Physician"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111S","DOI":"10.1177\/2192568219887364","article-title":"AOSpine consensus paper on nomenclature for working-channel endoscopic spinal procedures","volume":"10","author":"Hofstetter","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.wneu.2017.08.025","article-title":"Open versus minimally invasive surgery for extraforaminal lumbar disk herniation: A systematic review and meta-analysis","volume":"108","author":"Akinduro","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13018-017-0524-0","article-title":"Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: A surgical technique, outcome, and complications in 209 consecutive cases","volume":"12","author":"Gu","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1111\/os.13088","article-title":"A postoperative phenomenon of percutaneous endoscopic lumbar discectomy: Rebound pain","volume":"13","author":"Zhang","year":"2021","journal-title":"Orthop. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lin, G.X., Sun, L.W., Jhang, S.W., Chen, C.M., Rui, G., and Hu, B.S. (2022). Postoperative pain management after full endoscopic lumbar discectomy: An observational study. Medicina, 58.","DOI":"10.3390\/medicina58121817"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1586\/erd.12.23","article-title":"Transforaminal percutaneous endoscopic lumbar discectomy: Technical tips to prevent complications","volume":"9","author":"Ahn","year":"2012","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00586-005-0942-2","article-title":"Reliability of motion measurements after total disc replacement: The spike and the fin method","volume":"15","author":"Cakir","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/21925682231169963","article-title":"Annulus fibrosus repair for lumbar disc herniation: A meta-analysis of clinical outcomes from controlled studies","volume":"14","author":"Wang","year":"2024","journal-title":"Glob. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1097\/00007632-199608150-00013","article-title":"Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases","volume":"21","author":"Carragee","year":"1996","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00586-016-4821-9","article-title":"The effect of short (2-weeks) versus long (6-weeks) post-operative restrictions following lumbar discectomy: A prospective randomized control trial","volume":"26","author":"Bono","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.clineuro.2015.11.001","article-title":"Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre\u2019s experience using the far lateral approach","volume":"139","author":"Sanusi","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"18","DOI":"10.14444\/3018","article-title":"Transforaminal full-endoscopic lumbar discectomy in obese patients","volume":"10","author":"Bae","year":"2016","journal-title":"Int. J. Spine Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"E221","DOI":"10.36076\/ppj.2017.E231","article-title":"Full-endoscopic assisted lumbar decompressive surgery performed in an outpatient, ambulatory facility: Report of 5 years of complications and risk factors","volume":"20","author":"Kamson","year":"2017","journal-title":"Pain Physician"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2960","DOI":"10.3892\/etm.2017.4917","article-title":"Novel targeted puncture technique for percutaneous transforaminal endoscopic lumbar discectomy reduces X-ray exposure","volume":"14","author":"Zeng","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106","DOI":"10.21037\/atm.2018.02.26","article-title":"Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy","volume":"6","author":"Kosztowski","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E133","DOI":"10.36076\/ppj\/2019.22.E133","article-title":"Risk factors for early recurrence after transforaminal endoscopic lumbar disc decompression","volume":"22","author":"Park","year":"2019","journal-title":"Pain Physician"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"478","DOI":"10.7326\/0003-4819-147-7-200710020-00006","article-title":"Clinical efficacy assessment subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society","volume":"147","author":"Chou","year":"2007","journal-title":"Ann. Intern Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.13107\/jocr.2023.v13.i12.4052","article-title":"Analogy of lumbar disc: Retained, residual, or recurrent disc?","volume":"13","author":"Hadgaonkar","year":"2023","journal-title":"J. Orthop. Case Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"105868","DOI":"10.1016\/j.clineuro.2020.105868","article-title":"The incidence of symptomatic postoperative epidural hematoma after minimally invasive lumbar decompression: A single institution retrospective review","volume":"195","author":"Mueller","year":"2020","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4103\/0019-5413.98831","article-title":"Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases","volume":"46","author":"Basu","year":"2012","journal-title":"Indian J. Orthop."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1097\/BRS.0b013e3181abbfdf","article-title":"Rehabilitation after lumbar disc surgery: An update Cochrane review","volume":"34","author":"Ostelo","year":"2009","journal-title":"Spine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/2192568219893296","article-title":"The association between early postoperative leg pain intensity and disability at 1-year and 2-year follow-up after first-time lumbar discectomy","volume":"11","author":"Ziegler","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ahn, Y., Choi, J.E., and Lee, S. (2024). Access pain during transforaminal endoscopic lumbar discectomy for foraminal or extraforaminal disc herniation. Diagnostics, 14.","DOI":"10.20944\/preprints202408.1954.v1"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3344\/kjp.2022.35.1.97","article-title":"Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: A meta-analysis and systematic review","volume":"35","author":"Song","year":"2022","journal-title":"Korean J. Pain"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Alsiaf, H., O\u2019Neill, T.W., Callaghan, M.J., and Goodwin, P.C. (2022). Physical therapy of patients undergoing first-time lumbar discectomy: A survey of current UK practice. BMC. Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05346-1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:34:44Z","timestamp":1760031284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,18]]},"references-count":53,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103529"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103529","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,18]]}}}