Lumbar disc herniation (LDH) is a relatively common pathology usually presenting with unilateral radiculopathy ipsilateral to the disc herniation. Some patients can present with contralateral radicular symptoms. The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include prominent spondylotic changes and the accompanying stenosis; hypertrophic yellow ligament; dural attachments along the posterior longitudinal ligament; nerve root traction forces; and friction radiculitis, migrated epidural fat, nerve root anomaly, and venous congestion inside the vertebral canal. In our pooled analysis, 11 patients reported were treated by bilateral approach with 100% of clinical success and no complications. Eight patients were treated by unilateral approach ipsilateral to pain with 100% of clinical success and no complications. Forty-eight patients were treated by unilateral approach ipsilateral to herniation with 100% of clinical success and no complications. Pathophysiology underlying contralateral pain in LDH is probably multifactorial. There is not enough scientific evidence to define the best surgical approach for patients with LDH and contralateral pain.

腰椎间盘突出症（LDH）是一种相对常见的病理，通常表现为与椎间盘突出症同侧的单侧神经根病。一些患者可以表现出对侧的神经根症状。本文的目的是就有关对侧神经根病的腰椎间盘突出症的病理生理学和手术策略进行综述。使用MEDLINE（通过PubMed）使用MeSH术语对LDH伴有对侧神经根病的文献进行了系统的综述。这项审查是按照PRISMA声明和PICOT搜索策略的建议进行的。初步电子搜索确定了126篇论文。最后，对18篇文章进行了回顾。所包括的论文均未描述为可比较的。对侧疼痛的病理生理过程可能包括明显的脊柱变和随之而来的狭窄。肥厚的黄韧带; 沿后纵韧带的硬脑膜附件；神经根牵引力；和摩擦性神经根炎，硬膜外脂肪迁移，神经根异常和椎管内静脉充血。在我们的汇总分析中，报告的11例患者采用双侧方法治疗，临床成功率100％，无并发症。八名患者通过单侧入路疼痛治疗，临床成功率为100％，无并发症。通过单侧入路在同侧疝患者中治疗了48例患者，临床成功率为100％，无并发症。LDH对侧疼痛的病理生理学可能是多因素的。