Dec. 02, 2025
The Mayo Clinic in Minnesota not only offers traditional, open, and minimally invasive microdiskectomy for lumbar disk herniations (LDHs) — what patients often refer to as a slipped or ruptured disk — but also recently began offering an ultra-minimally invasive alternative: transforaminal endoscopic lumbar diskectomy (TELD). TELD has been highly popular in Asia, but has increased in popularity within the United States, according to Mel D. Helgeson, M.D., an orthopedic spinal surgeon at Mayo Clinic in Rochester, Minnesota.
While acute or degenerative LDH is a relatively straightforward spinal condition, the goal in every case is to remove pressure from the nerves. However, Mayo Clinic often sees the most complex cases and needs to use all available tools, says Dr. Helgeson. Due to the minimally invasive nature of TELD, the time for surgical wound healing is significantly less. In contrast, traditional, open microdiskectomy requires an approximately six-week healing period.
To successfully perform a TELD, Dr. Helgeson notes that a surgeon must be comfortable operating in the spinal region with its inherent challenges and risks and must be dedicated to using TELD thoughtfully in cases most appropriate to the technique.
TELD's emergence at Mayo Clinic in Minnesota
Room set up
Dr. Helgeson and team arrange all facets of the operating room for a TELD, including 2D screen.
Disk removal
The surgeon performs the herniated disk removal with a nerve hook.
Herniated disk, tissue
The surgeon removes the herniated portion of the disk and any excess tissue adjacent to the nerve.
Currently at Mayo Clinic in Minnesota, Dr. Helgeson is leading the endoscopic program, with three additional spinal surgeons expanding their endoscopic techniques. One of the challenges in this training is to become accustomed to using a surgical camera with a 2D screen, says Dr. Helgeson. He used endoscopic technology prior to starting his position at Mayo Clinic in 2024, and Mayo Clinic recently acquired similar equipment.
When performing a TELD, Dr. Helgeson places an endoscope with a camera into the patient's foramen to look for the herniated disk previously identified on imaging and physical exam. He removes the herniated portion of the disk and any excess tissue adjacent to the nerve with tools inserted through the endoscope.
Dr. Helgeson performed Mayo Clinic in Minnesota's first TELD in December 2024, and the practice rapidly expanded due to positive patient results and patient interest.
"Our first patient here did great — he stated he's 99% better," says Dr. Helgeson. "Previously, this patient was scheduled for a fusion, but we offered him TELD instead. He only had a 7-mm incision and returned to work promptly. The TELD does not limit his motion at all."
Dr. Helgeson says that he and his team are now performing endoscopic procedures every week.
Benefits of TELD for patients
TELD offers several benefits compared with traditional, open microdiskectomy:
- Smaller incision.
- Decreased time in surgery and in hospital.
- Easier recovery.
- Decreased pain.
- Faster return to activity.
Eligibility for TELD
Dr. Helgeson indicates it is important to note that while TELD offers many advantages, all patients with LDH are not candidates for this procedure. An ideal candidate for TELD has radiating leg pain that correlates to a disk herniation accessible from a transforaminal approach. In addition to TELD, Dr. Helgeson's team performs interlaminar decompressions and medial branch transections in the lumbar spine.
For more information
Refer a patient to Mayo Clinic.