Clinical Study Of Percutaneous Endoscopic Transforaminal Discectomy In The Treatment Of Calcified Lumbar Disc Herniation

ObjectiveCalcified lumbar disc herniation(CLDH)is a special type of lumbar disc herniation,which mostly occurs in patients with a longer course of disease and older age.CLDH often leads to intervertebral disc-derived spinal canal stenosis and compression of nerve roots,resulting in root pain.In addition,the calcified focus is hard and often attached to the nerve root and dura mater.Once diagnosed,the operation should be performed as soon as possible to relieve the compression of the nerve tissue.Non-operative treatment may aggravate the friction or entrapment of calcification on nerve roots.Traditional open surgery is the main clinical treatment,which can effectively relieve clinical symptoms.However,due to the large trauma of open surgery,it is inevitable to destroy too much bony structure and affect the stability of the spine.Since percutaneous endoscopic transforaminal discectomy(PETD)has been widely used,transforaminal approach has achieved good results in the treatment of lumbar disc herniation.However,the clinical treatment of CLDH with PETD is still controversial,and there is no imaging classification and classification of the type and size of calcification of protruded intervertebral disc tissue and the degree of calcification of protruded intervertebral disc tissue.In this study,the imaging(CT)classification of LDH was carried out,and the clinical efficacy of PETD in the treatment of CLDH and the correlation between different types and efficacy were explored,so as to provide a basis for the selection of clinical surgical methods for this kind of patients.MethodsFrom August 2012 to August 2018,40316 cases of lumbar disc herniation in CT room of Henan Provincial People's Hospital were investigated,including 5587 cases of lumbar disc herniation with calcification.The maximum calcification area / total protruding area was graded according to the percentage of the maximum calcification area to the total protruding area on CT images.Degree ?: < 25%,degree ?: 25%,degree ?: 25%,degree ?: 51%,degree 75%,degree ?: > 75%.According to the relationship between the position of calcification and the posterior edge of vertebral body on CT sagittal images,the patients were classified.Type A(free type): there was no bony connection between calcification and upper and lower vertebrae,type B(fixed type): type B1: calcification and posterior inferior edge of superior vertebral body;type B2: calcification and posterior superior margin of inferior vertebral body;type B3: there was bony connection between calcification and posterior inferior edge of superior vertebral body and posterior superior edge of inferior vertebral body.The data of CLDH 143 patients treated with PETD in the Department of Spinal surgery of Henan Provincial People's Hospital from June 2015 to August 2018 were analyzed retrospectively.According to the CT grade mentioned above,the patients were divided into grade ? group(n = 35),grade ? group(n = 38),grade ? group(n = 39)and grade ? group(n = 31).According to the above CT classification,the patients were divided into type A group(n = 39),type B1 group(n = 30),type B2 group(n = 41)and type B3 group(n = 33).Visual analogue scale(VAS)of pain and Oswestry dysfunction index(ODI)were recorded and analyzed before operation,1 week,6 months after operation and the last follow-up in different groups.At the last follow-up,the clinical efficacy was evaluated according to the modified Mac Nab criteria.ResultsAll cases completed the operation successfully and were followed up for at least 12 months.There was no loss of follow-up.The VAS at 1 week,6 months and the last follow-up were 3.76 ±1.24,2.78 ±0.99,2.26 ±0.85,respectively,which were significantly lower than those before operation(P < 0.05),and the ODI were 40.65 ±8.82,28.20 ±7.75,24.75 ±6.96 at 1 week,6 months and the last follow-up,respectively,which were significantly lower than those before operation(65.44 ±11.98).At the last follow-up,according to the improved Mac Nab evaluation criteria,the excellent and good rate was 87.71%.In the grading group,the VAS and ODI at each follow-up time point in the grade ?,?,? and ? groups were significantly lower than those before operation.There was no significant difference in VAS and ODI scores at each follow-up time point in grade ?,? and ? groups,but there was significant difference between grade ?,? and ? group and grade ? group at each follow-up time point(P < 0.05).At the last follow-up,according to the improved Mac Nab evaluation criteria,the excellent and good rate was 94.12% in the grade ? group,92.11% in the grade ? group,87.18% in the grade ? group and 77.42% in the grade ? group.Classification group: the VAS and ODI of type A,B1,B2 and B3 groups at each follow-up time point after operation were significantly lower than those before operation.There was no significant difference in VAS and ODI scores at each follow-up time point among the A,B1 and B3 groups,but there was significant difference compared with the B3 group at each follow-up time point(P < 0.05).At the last follow-up,according to the improved Mac Nab evaluation criteria,the excellent and good rates of type A group,type B1 group,type B2 group and type B3 group were 92.31%,93.33%,85.37% and 75.76%,respectively.Conclusionpercutaneous endoscopic transforaminal discectomy has achieved satisfactory clinical results in the treatment of calcified lumbar disc herniation.The curative effect of grade ?,?,? and type A,B1,B2 calcified lumbar disc herniation was definite,while that of grade ? and B3 was not good.