Transforaminal Endoscopic Ventral Stenosis Decompression in Calcified Lumbar Disc Herniation: A Long Term Outcome in 79 Patients

Abstract

BackgroundCalcified lumbar disc herniations(CLDH) causing calcified ventral stenosis CVS) pose a therapeutic challenge to the treating surgeon due to their neural adhesions, location, and hardness. MethodsThis retrospective study analyzed all the cases of CLDH/CVS managed by transforaminal endoscopic lumbar discectomy(TELD) with a minimum follow-up of 24 months. The pre-operative images were analyzed for the level, migration; and grade(Lee’s migration zones), and location(MSU classification). Detailed surgical technique and intra-operative parameters including the duration of surgery, and complications have been recorded. The clinical parameters including VAS, ODI, length of stay (LOS) in hospital, days of return to basic work, and patient satisfaction index(PSI) were analyzed. Post-operatively the images were analyzed for the adequacy of decompression. ResultsThe mean VAS for back pain and leg pain was 4.7±2.6(0-9), and 7.45±2.2(1-10) respectively. The mean pre-operative ODI was 78.2±13.2(63.2-95.6). Nineteen patients(24%) had neurological deficits pre-operatively. The mean duration of surgery was 90.5±15.8(58- 131) minutes. Post-operative MRI revealed adequate decompression in 97.5%(n=77). The mean duration of hospital stay was 1.05±0.22(1-2) days, and the post-operative back and leg pain VAS was 1.14±1.2 (0-3) (p<0.05) and 1.7±0.5 (0-6)(p<0.05). The ODI at final follow-up was 6.5±3.7(2.2-18)(p<0.05). Neurological recovery occurred in 17(89.5%) patients and they returned to basic work/jobs in 19.5±3.3(14-26) days. The mean PSI was 1.18±0.47(1-2) at a mean follow-up of 5.52±2.91(2-12.75) years. ConclusionTELD is a complete, safe, and efficacious procedure in patients with CLDH with earlier recovery considering the surgery is performed with the patient being awake.