Background:
Clinically, lumbar disc herniation (LDH) presenting with concurrent bilateral radicular symptoms is relatively uncommon. For this condition, both conventional open surgery and UBE for bilateral decompression inherently entail a partial compromise of spinal structural integrity due to the requirement for extensive bony resection or facet joint violation during the procedure. The management of such complex cases via unilateral percutaneous transforaminal endoscopic discectomy (PTED) constitutes a technical paradigm requiring multidimensional surgical expertise. Our aim was to explore the feasibility of unilateral PTED in treating non-calcified massive LDH with bilateral radiculopathy.
Methods:
A retrospective analysis was conducted on 32 patients who underwent unilateral PTED. During the procedure, adequate foraminoplasty was performed to optimize working channel maneuverability during decompression. Simultaneous decompression and channel advancement were employed to minimize nerve root compression during instrument placement. The ipsilateral nerve root was fully explored, while the contralateral nerve root was decompressed until no residual compression was identified under direct visualization or ventral probing with a radiofrequency electrode confirmed patency.
Results:
The mean surgical duration was 72.5 ± 10.3 min, with an average intraoperative blood loss of 5.5 ± 1.3 mL. No complications such as incision or intervertebral space infections or nerve injuries were observed. Postoperatively, patients demonstrated statistically significant improvements in lower limb and low back pain VAS scores, ODI, and modified MacNab compared to preoperative values (p < 0.05).
Conclusion:
Unilateral PTED is a safe and effective treatment for non-calcified massive LDH with bilateral radiculopathy. This technique facilitates precise bilateral nerve root decompression via a single-incision working channel, achieving adequate bilateral foraminal and central canal decompression while preserving spinal stability and structural integrity. It effectively alleviates bilateral radicular symptoms, promotes rapid recovery, and improves patients' quality of life.