Full Endoscopic Bilateral Discectomy at L5/S1 Level

Study Design: Technical report. Objective: This report aimed to describe a 3-step unilateral uniportal interlaminar circum-dural approach for entire spinal canal inspection and bilateral discectomy at L5/S1 level. Summary of Background Data: Treatment of lumbar disc herniation with bilateral symptoms at L5/S1 level is complicated in full endoscopic surgeries. Unilateral interlaminar approaches have been used for bilateral discectomy at L5/S1 level through a uniportal ventral dural approach or a biportal dorsal dural approach. Despite the reporting of successful clinical outcomes, inspection and manipulation of the entire spinal canal via a unilateral approach remain challenging. Methods: The 3-step inspection of the entire spinal canal includes the ipsilateral side, the midline, and the contralateral side. Two typical cases are provided to further demonstrate the technique. In case 1, bilateral symptoms were caused by bilateral multifocal herniations. In case 2, bilateral symptoms were caused by a huge midline herniation. Results: The surgical purposes were achieved as intended in both of the 2 cases. The herniations were successfully removed and the pain was relieved immediately after surgery. Conclusions: As indicated by the preliminary application, the present technique, integrating the advantages of both the ventral and the dorsal dural approaches, is probably an ideal choice for bilateral discectomy at L5/S1 level.