Managing large central lumbar disc herniation (LDH) often involves complex surgical decisions, especially when patients present with bilateral neurological symptoms. Traditional approaches frequently require extensive bone removal or fusion. However, a recent retrospective study explores the efficacy of unilateral PTED bilateral decompression as a minimally invasive solution for these challenging cases. This technique allows surgeons to address bilateral compression through a single portal, significantly reducing tissue trauma.

The Efficacy of Unilateral PTED Bilateral Decompression

The study evaluated 34 patients with large central LDH and bilateral symptoms who underwent the unilateral approach. Researchers focused on clinical outcomes such as pain reduction and functional improvement over a two-year follow-up period. Notably, the visual analog scale (VAS) for back and leg pain decreased significantly. Furthermore, the Oswestry Disability Index (ODI) scores showed marked improvement at all postoperative intervals. Consequently, the modified MacNab criteria revealed a high patient satisfaction rate of 91.2%.

Surgical efficiency and safety were also key highlights of the research. On average, the operative time was approximately 85 minutes, with minimal intraoperative blood loss of about 81 mL. Additionally, the average length of hospitalization was only 32 hours. These findings suggest that unilateral PTED bilateral decompression provides a reliable alternative to traditional open surgery by offering faster recovery and significant dural sac expansion.

Technical Advantages and Safety Profile

One primary concern with unilateral approaches is the adequacy of contralateral decompression. This study demonstrated that the transforaminal route effectively clears central and bilateral compression by carefully navigating the spinal canal. Although one patient experienced a cerebrospinal fluid leak and another faced symptom recurrence, the overall complication rate remained low. Therefore, the approach maintains a favorable safety profile while achieving the surgical goals of decompression and stabilization.

Frequently Asked Questions

What is the success rate of unilateral PTED for bilateral symptoms?

According to the 2-year retrospective study, the satisfaction rate based on modified MacNab criteria was 91.2%, with significant improvements in both VAS and ODI scores.

How does a unilateral approach achieve bilateral decompression?

Surgeons utilize a specific endoscopic technique that allows them to reach across the midline. This effectively decompresses the contralateral side and the central canal through a single unilateral incision.

Is recovery faster with PTED compared to open surgery?

Yes. The study reported an average hospitalization of just 32 hours and minimal blood loss, which generally leads to a quicker return to daily activities compared to traditional open discectomy.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare provider regarding any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Huang Y et al. Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study. Med Sci Monit. 2026 Mar 22. doi: 10.12659/MSM.951022. PMID: 41865237.

Jasper GP et al. Clinical success of transforaminal endoscopic discectomy with foraminotomy: A retrospective evaluation. Clin Neurol Neurosurg. 2013;115:1961-5.

Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27(7):722-31.