Microsurgical Bilateral Discectomy via a Unilateral Approach for Huge Central Lumbar Disc with the CO2 Laser

Objective: Large central disc herniation is not common. Generally, wide and aggressive surgery is required for total disc removal. But, wide decompression such as total laminectomy for adequate disc removal may have risk of spinal instability. Methods: We operated on large central disc herniation by microsurgical Bilateral Discectomy via a Unilateral Approach (BDUA). With modification of this technique which has been traditionally used for lumbar stenosis, the authors could easily visualize the contralateral dura and traversing root and could create adequate space to perform a complete discectomy with the CO2 laser. Results: All patients showed improvement in the clinical outcome and total removal was confirmed on the first postoperative day magnetic resonance (MR) images. Follow-up X-ray showed no aggravation of spinal instability. Conclusion: BDUA with the CO2 laser can achieve good decompression without fusion and can be an alternative treatment option for a large central disc, especially in young and middle-aged patients.