Elsevier

World Neurosurgery

Volume 119, November 2018, Pages 500-505
World Neurosurgery

Minimally Invasive Surgery—Special Section
Full Endoscopic Lumbar Discectomy using the Calcification Floating Technique for Symptomatic Partially Calcified Lumbar Herniated Nucleus Pulposus

https://doi.org/10.1016/j.wneu.2018.06.133Get rights and content

Highlights

  • Partially calcified lumbar HNP can cause severe radiating pain and neurologic symptoms requiring surgical treatment.

  • It is not safe to enforce conventional endoscopic discectomy using trephine or burr to remove the partially calcified disc.

  • The calcification floating technique is safe and complete decompression of neural structures is possible with it.

Background

Partially calcified lumbar herniated nucleus pulposus (HNP) can cause severe radiating pain and neurologic symptoms requiring surgical treatment. As it is not safe to enforce conventional endoscopic lumbar discectomy using trephine or burr to remove the partially calcified disc, we report a calcification floating technique using a working channel for the treatment of these cases.

Methods

We retrospectively analyzed 31 patients who underwent full endoscopic discectomy using this technique for partially calcified lumbar HNP between April 2009 and June 2013. Calcification floating technique was performed by inserting the working channel around the partially calcified HNP and then rotating the working channel around it to remove the lesion. We analyzed the outcomes with a Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and complication rate.

Results

The mean follow-up period was 26.58 ± 11.2 months. The interlaminar approach was used in 15 cases, and the transforaminal approach was used in 16 cases. The mean VAS of 8.19 ± 0.65 before surgery was decreased to 1.29 ± 0.69 at the last follow-up. The mean ODI score before surgery was decreased at the last follow-up, from 41.32 ± 2.87 to 9.87 ± 3.47. Mean operative duration was 45 ± 12 minutes per level. None of the patients required revision surgery or developed any major complication.

Conclusions

Calcification floating technique is a safe and effective method for the treatment of partially calcified lumbar HNP.

Introduction

Partially calcified herniated nucleus pulposus (HNP) is an uncommon type of lumbar disc herniation. The prevalence of intervertebral disc calcification detected by conventional radiography in the general adult population has been previously reported as 5%–6%.1, 2 The specific etiology of calcification is not yet clear.3 Calcification is thought to be related to the developmental changes in the nucleus pulposus, and unknown triggering factors (e.g., infection, microtrauma, impaired blood flow, metabolic diseases) can initiate an inflammatory response.4

Partially calcified lumbar disc herniation can cause severe radiating pain and neurologic symptoms. Only targeted direct decompression within the spinal canal can completely decompress the nerve root in cases of partially calcified disc herniations.3 However, it is not easy to enforce the percutaneous endoscopic lumbar discectomy to remove the calcified disc using a conventional endoscopy technique. The incidence of postoperative dysesthesia using trephine or burr in the conventional technique is high.3 We report the clinical and radiologic outcomes of endoscopic this calcification floating technique for partially calcified HNP.

Section snippets

Materials and Methods

Electronic medical records of 31 consecutive patients operated between April 2009 and June 2013 with this technique were reviewed retrospectively. Inclusion criteria were as follows: (1) patients with a diagnosis of degenerative partially calcified lumbar disc herniation (on computed tomography [CT]) with intraspinal and extraforaminal location and (2) patients managed with all conservative measures for at least 3 months. Exclusion criteria were as follows: (1) patients with frank segmental

Results

The endoscopic calcification floating technique for partially calcified HNP was performed in 31 patients between April 2009 and June 2013. The mean age of the patients was 43.7 ± 11.2 years (range, 18–63 years) with 17 men and 14 women (Table 1). The follow-up period was 26.6 ± 11.2 months (range, 12–60 months). We performed 15 procedures using the interlaminar approach and 16 procedures using the transforaminal approach. Mean operative duration was 45 ± 12 minutes per level. The average length

Discussion

Partially calcified HNP is a condition with calcium pyrophosphate dihydrate or hydroxyapatite accumulation in the nucleus pulposus or annulus fibrosus.8 Eighty percent of the patients with partially calcified HNP have back and leg pain. Neurologic signs can be seen in the acute phase because of a disc protrusion that causes nerve root or spinal cord compression.8, 9, 10 Usually, calcified discs herniate slightly more than noncalcified discs.8 CT scan is more valuable than MRI in showing partial

Conclusion

According to the results, we obtained good long-term clinical outcomes using the calcification floating technique of percutaneous endoscopic lumbar discectomy for symptomatic partially calcified lumbar HNP. This technique is safe, and complete decompression of neural structures is possible with it.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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