Is a Unilateral Surgical Approach Effective in Patients with Bilateral Leg Pain with Unilateral Lumbar Disc Herniation? A Prospective Nonrandomized Clinical and Surgical Study Ihsan Dogan 1 , Melih Bozkurt 1 , Gokmen Kahilogullari 1 , Fatih Yakar 1 , Murat Zaimoglu 1 , Batuhan Bakirarar 2 , Cihan Kircil 3 , Umit Eroglu 1 , Onur Ozgural 1 , Melih Ucer 4 , Cemil Kilinc 1 , Altan Demirel 5 , Efe Guner 6 , Hasan Caglar Ugur 1 , Yusuf Sukru Caglar 1 - OBJECTIVE: To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. - METHODS: We analyzed 60 patients with unilateral disc herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disc herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disc herniation. Pain scores were preoperatively evaluated with visual analog scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disc levels were compared in group 1. ODI score differences were compared between both groups. Results were sta- tistically analyzed. - RESULTS: VAS score differences were statistically sig- nificant at all follow-up time points in patients with ipsi- lateral and contralateral pain. VAS score differences between L4eL5 and L5eS1 level discopathies were sta- tistically insignificant for all time points in both groups. All postoperative ODI score decreases for all time points were statistically significant (P < 0.001) for both groups, whereas the differences between groups 1 and 2 were statistically insignificant. - CONCLUSIONS: Conventional lumbar disc surgery alone is sufficient for the ipsilateral side of radiologically demonstrated disc herniation in patients with bilateral leg pain. INTRODUCTION L umbar disc herniation (LDH) is responsible for nearly 74%e100% of lifetime incidence of back pain. 1 Radiating pain in one or more lumbar/sacral dermatomes with irritation symptoms and/or decreased function describes lumbosacral radicular syndrome (LRS). 2 Common LRS causes are disc herniation, degenerative vertebrae, and foraminal narrowing where the nerves exit the spinal canal. 3 The incidence of LRS caused by LDH is 5 cases per 1000 persons. 4 The most common symptom of LDH is lumbosacral radicular leg pain, which has a dermatomal pattern and is provoked with an increase in intra-abdominal pressure. The pain settles below the knee to the feet and toes. 5 LDH usually causes unilateral neurologic symptoms with low back pain, whereas bilateral Key words - Bilateral leg pain - Oswestry Disability Index - Pain score - Unilateral discectomy - Visual analog scale Abbreviations and Acronyms LDH: Lumbar disc herniation LRS: Lumbosacral radicular syndrome MRI: Magnetic resonance imaging ODI: Oswestry Disability Index SLR: Straight leg raise VAS: Visual analog scale From the 1 Department of Neurosurgery, Ankara University, School of Medicine, Ibni Sina Hospital, Ankara; 2 Department of Biostatistics, Ankara University School of Medicine, Ankara; 3 Department of Ortopedia and Traumatologia, Memorial Hospital, Ankara; 4 Istanbul Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul; 5 Department of Neurosurgery, Aksaray State Hospital, Aksaray; and 6 Department of Neurosurgery, Ankara Koru Hospital, Ankara, Turkey To whom correspondence should be addressed: Ihsan Dogan, M.D. [E-mail: ihsandogan@ankara.edu.tr] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.06.022 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e7, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article