Unilateral surgical approach for lumbar disc herniation with contralateral symptoms

Clinical article

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In most cases of lumbar disc herniation, the primary problem is usually limited to radicular pain due to nerve compression on the herniated side, which is generally limited to the side of operation. The aim of this study was to reevaluate the side of the surgical approach in a selected group of patients with leg pain and contralateral lumbar disc herniation.


Included in this study were a total of 5 patients with lumbar disc herniations who presented with contralateral symptoms and neurological signs. In all cases, patients underwent a microdiscectomy from the side ipsilateral to the herniated lumbar disc, the side contralateral to the motor deficits and leg pain.


The symptoms and signs, to some extent, resolved during the immediate postoperative period. There were no postoperative complications.


The findings confirm that performing a laminotomy via the side of the herniation is sufficient for this group of patients.

Article Information

Current affiliation for Dr. Kaner: Department of Neurosurgery, Medeniyet University Faculty of Medicine, Istanbul, Turkey

Address correspondence to: Taşkan Akdeniz, M.D., Department of Neurosurgery, Küçükyalı Delta Hospital, Akgüvercin Sok. No. 4, Istanbul, Turkey. email: taskanakdeniz5924@gmail.com.

Please include this information when citing this paper: published online June 8, 2012; DOI: 10.3171/2012.4.SPINE11365.

© AANS, except where prohibited by US copyright law.



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    Case 1. Preoperative and immediate postoperative images of the herniation level obtained in a 57-year-old woman with right leg pain. Surgery was conducted via the symptomatic side only.

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    Case 2. Preoperative and immediate postoperative images of the herniation level obtained in a 30-year-old man with left leg pain and neurological deficits.

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    Case 5. Preoperative and immediate postoperative images of the herniation level obtained in a 36-year-old woman with right leg pain and neurological deficits.



Buchowski JMDaubs MDTransforaminal lumbar interbody fusion. Vaccaro ARBaron EM: Operative Techniques: Spine Surgery PhiladelphiaSaunders Elsevier2008. 401408


Burton CVKirkaldy-Willis WHYong-Hing KHeithoff KB: Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 157:1911991981


Choudhury ARTaylor JCWorthington BSWhitaker R: Lumbar radiculopathy contralateral to upper lumbar disc herniation: report of 3 cases. Br J Surg 65:8428441978


Dösoğlu MIs MGezen FZiyal MI: Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: case report and review of the relevant literature. Eur Spine J 10:3483512001


Frymoyer JWSelby DK: Segmental instability. Rationale for treatment. Spine (Phila Pa 1976) 10:2802861985


Fujibayashi SNeo MTakemoto MOta MNakamura T: Paraspinal-approach transforaminal lumbar interbody fusion for the treatment of lumbar foraminal stenosis. Clinical article. J Neurosurg Spine 13:5005082010


Jenis LGAn HS: Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976) 25:3893942000


Kirkaldy-Willis WHFarfan HF: Instability of the lumbar spine. Clin Orthop Relat Res 165:1101231982


Kornberg M: Sciatica contralateral to lumbar disk herniation. Orthopedics 17:3623641994


Lee DYLee SH: Recurrent lumbar disc herniation with contralateral symptoms treated by percutaneous endoscopic discectomy. Kor J Spine 4:41432007


Mirovsky YHalperin N: Eccentric compression of the spinal canal causing dominantly contralateral-side symptoms. J Spinal Disord 13:1741772000


Naosuke KMasanobu SHiroyuki MYoshinori SYo O: [A case report of lumbar disc herniation with greater contralateral symptoms than ipsilateral symptoms.]. JCSOA 14:69722002. (Jpn)


Scapinelli R: The meningovertebral ligaments as a barrier to the side-to-side migration of extruded lumbar disc herniations. Acta Orthop Belg 58:4364411992


Sucu HKGelal F: Lumbar disk herniation with contralateral symptoms. Eur Spine J 15:5705742006




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