Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc...

BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) has been widely applied for lumbar disc herniation (LDH) in recent years; however, the achievement of bilateral decompression through a conventional unilateral PTED approach remains a key challenge. This retrospective study evaluated outcomes after unilateral PTED among patients with lumbar stenosis due to a large central LDH and concomitant bilateral neurological symptoms. MATERIAL AND METHODS From January 2018 to December 2020, 34 patients aged 22 to 54 years with large central LDH and concomitant bilateral neurological symptoms received treatment via unilateral PTED. The visual analog scale (VAS), Oswestry Disability Index (ODI), and dural sac area were used to assess clinical efficacy before and after surgery. At the final follow-up, modified MacNab criteria were used to evaluate the satisfaction rate. RESULTS Intraoperative blood loss was 81.56±14.72 mL (range, 50-110). Operative time was 85.12±13.43 min (range, 65-113). Length of hospitalization was 32.06±9.52 h (range, 24-72). Follow-up duration was 34.21±6.54 months (range, 24-48). VAS and ODI scores for low back and leg pain significantly improved at all postoperative time points (P<0.05). The satisfaction rate, based on modified MacNab criteria, was 91.2%. Cerebrospinal fluid leakage occurred in 1 patient, and postoperative symptom recurrence occurred in 1 patient. CONCLUSIONS This study confirms that unilateral PTED can achieve bilateral decompression with safe and reliable outcomes in the treatment of large central LDH and concomitant bilateral neurological symptoms, substantially relieving low back and leg pain and improving limb function.