The aim of the study was to compare the effects of unilateral and bilateral approach percutaneous interlaminar laminectomy (PELD) for the treatment of lumbar disc herniation at L₃-S₁ segment, focusing on the assessment of pain relief, functional recovery, postoperative complications, and patient satisfaction, and to analyse its efficacy and safety.

Sixty patients with lumbar disc herniation were included in the study, there were 20 male cases and 40 female cases, aged from 18 to 70 years, with an average age of (48.8±6.1) years, and were divided into unilateral approach group and bilateral approach group according to the surgical approach, with 30 cases in each group. All patients were treated with PELD surgery and followed up for 6 months after surgery. The main assessment indexes included visual analogue score (VAS), Japanese Orthopaedic Association score (JOA), Oswestry dysfunction index (ODI) and postoperative complications.

The VAS scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (7.1±1.2), (4.3±0.8), (2.2±0.6), (1.6±0.5), and (1.3±0.4), respectively. Those of the bilateral approach group were (7.3±1.2), (4.7±0.9), (2.5±0.7), (2.0±0.6), and (1.7±0.5), respectively. There were statistically significant differences between different groups and time points (F=4.251, P=0.04; F=325.604, P=0.000), and there was an interaction between groups and time points (F=3.201, P=0.015). The JOA scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (12.4±2.1), (16.1±1.6), (18.4±1.4), (20.1±1.3), and (20.8±1.2), respectively. Those of the bilateral approach group were (12.5±2.2), (15.7±1.5), (17.9±1.3), (17.9±1.3), and (20.0±1.1), respectively. There were statistically significant differences between different groups and time points (F=5.128, P=0.128; F=598.354, P=0.000), and there was an interaction between groups and time points (F=15.246, P=0.015). The Oswestry Disability Index of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (51.8±7.0), (37.5±6.3), (30.2±5.5), (24.5±4.7), and (20.8±4.1), respectively. Those of the bilateral approach group were (52.1±7.3), (39.0±6.5), (31.0±5.8), (26.0±4.9), and (22.1±4.4), respectively. There were statistically significant differences between different groups and time points (F=4.317, P=0.043; F=485.726, P=0.000), and there was an interaction between groups and time points (F=4.128, P=0.003). The infection rate of the bilateral approach group was 13.3%, significantly higher than that of the unilateral approach group (0%) (P<0.05). There was no significant difference between the two groups in terms of postoperative patient satisfaction (P>0.05).

The unilateral approach to PELD surgery was superior to the bilateral approach in reducing pain, improving functional recovery, and reducing postoperative complications, and both groups had higher postoperative patient satisfaction. Unilateral approach as an effective choice for the treatment of lumbar disc herniation at L3-S1 segment has better clinical results.