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