Unilateral Approach for Bilateral Lumbar Disc Herniation: A Tissue-Preserving Technique

Abstract Minimally-invasive techniques are increasingly preferred for lumbar discectomy. To evaluate the feasibility and clinical outcomes of a tissue-preserving unilateral approach for managing bilateral lumbar disc herniation. We conducted a retrospective review of two patients who underwent bilateral root decompression via a single unilateral portal. The surgical technique focused on “over-the-top” decompression to address the contralateral side while minimizing structural disruption. Both patients were discharged on the first postoperative day without neurological deficits or residual pain. At the 1-year follow-up, both remained asymptomatic with no reported complications or recurrence. The unilateral approach for bilateral lumbar discectomy effectively preserves the spine's midline structures and enhances postoperative contralateral stability. This technique offers a viable alternative to traditional bilateral approaches, potentially reducing tissue trauma and surgical morbidity in patients presenting with bilateral radiculopathy.