Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study

  • Kang Li
  • Kai Gao
  • Tao Zhang
  • Chao-liang LvEmail author
Original Article



In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms.


A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups.


The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05).


For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Percutaneous endoscopic lumbar discectomy Unilateral transforaminal approach Lumbar disc herniation Bilateral symptoms 



This study was supported by Shandong Science and Technology Development Plan on Medicine and Hygiene in China (Grant Number: 2017WS519). This study was also supported by Jining Science and Technology Boosting New and Old Energy Conversion Plan in China (Grant Number: 2017SMNS010).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6210_MOESM1_ESM.pptx (11.6 mb)
Supplementary material 1 (PPTX 11927 kb)
586_2019_6210_MOESM2_ESM.tif (936 kb)
Supplemental Fig. 1A schematic drawing showing PELD through unilateral interlaminar approach for L5/S1 LDH with bilateral symptoms. Due to limitation of vertebral plate and facet joint, the traction of dura sac during contralateral discectomy is severe. (TIFF 935 kb)
586_2019_6210_MOESM3_ESM.tif (484 kb)
Supplemental Fig. 2A schematic drawing showing PELD through unilateral transforaminal approach for L5/S1 LDH with bilateral symptoms. Due to the limitation of iliac crest, the angle from working cannula to disc plane is too great for working cannula to be inserted parallel with disc plane, which limits the exposure of contralateral spinal canal and remove contralateral herniated disc. The blue zone shows ipsilateral herniated disc and the red zone shows contralateral herniated disc. (TIFF 483 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Spine SurgeryJining No. 1 People’s HospitalJiningPeople’s Republic of China
  2. 2.Department of Spine SurgeryAffiliated Jining No. 1 People’s Hospital of Jining Medical University, Jining Medical UniversityJiningPeople’s Republic of China
  3. 3.Department of Joint SurgeryJining No. 1 People’s HospitalJiningPeople’s Republic of China

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