Early Pain Trajectories and Their Predictive Value in Lumbar Disc Herniation Treated with Transforaminal Full-Endoscopic Discectomy

Background: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive procedure that enables rapid recovery for symptomatic lumbar disc herniations. However, early postoperative pain trajectories and their prognostic value remain insufficiently characterized. Methods: A multicenter retrospective cohort study was conducted in 97 patients (104 levels) who underwent TELD between 2021 ‐ 2024 at 11 spine‐specialized centers. Patient‐reported outcomes (Visual Analog Scale [VAS] for low back and leg pain; Oswestry Disability Index [ODI]) were collected preoperatively and serially through postoperative day (POD) 180 using a validated mobile platform (SPINEhealthie). A ≥30% ODI improvement at final follow‐up defined a good outcome. Comparisons were performed using repeated‐measures ANOVA and receiver operating characteristic (ROC) analyses. Results: Mean age was 54.1 ± 1.5 years; 55.7% were male. Overall, 69.1% of our patients achieved good outcomes. LBP and leg pain improved significantly by POD1 (VAS‐LBP: 6.0; 3.8, respectively. p<0.001; VAS‐leg: 6.7;2.9, respectively. p<0.001), while ODI improved gradually through POD90 (p<0.001). Foraminal herniations showed worse outcomes (46.1% good) compared to central/paracentral lesions (84.2%, p<0.001). Early reduction in leg pain correlated with short‐term success (AUC=0.717; cutoff −2.75, sensitivity 70.0%, specificity 68.2%). In foraminal LDH, both leg pain and ODI improvements at POD1 predicted good outcomes (AUC=0.726 and 0.700, respectively). Conclusions: TELD provides rapid relief of pain and functional improvement. Early postoperative reduction in leg pain, particularly within the first 24 hours, is a fair predictor of midterm recovery. Mobile app‐based outcome tracking enables early identification of patients at risk for poor recovery and may inform timely postoperative interventions.