Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study

Figures & data

Figure 1 Flow chart of the study.

Table 1 Preoperative Demographic Characteristics

		A (Calcified) n=50	B (Non-Calcified) n=54	p-value
Age^a (years)		49.9±14.5	53.2±15.3	0.202
Sex^b (n)	Male	20	22	0.939
	Female	30	32
Segments^b (n)	L1-L2	4	2	0.717
	L2-L3	1	1
	L3-L4	4	5
	L4-L5	14	21
	L5-S1	27	25
BMI^a (kg/m2)		25.8±3.1	26.2±3.7	0.133

Notes: ^aExhibited in the format of “Mean ± standard deviation” and tested by Student’s t-test. ^bChi-squared test. Data are presented as number of patients.

Abbreviation: BMI, body-mass index.

Figure 2 The patient’s position. The patient was placed in the lateral decubitus position after entering the operating room, whose Hip and knee were flexed, and a lumbar pillow was placed under the lesion to aid access to the intervertebral foramen. The height of normal saline stent is about 1.8m, and the height from the operating table is about 1m.

Figure 3 Intraoperative views. (A) The intervertebral foramen was remolded with a endoscopic osteotome. (B) After secondary molding, the calcified disc pressing on the nerve root was exposed. (C) Calcified discs were removed in fragments. (D) After decompression, the nerve roots showed good pulsation.

Table 2 Perioperative Outcomes

	A (Calcified)	B (Non-Calcified)	p-value
Blood loss (mL)^b	20 (2–50)	20 (5–50)	0.714
Hospital stay (days)^b	6 (3–9)	5.5 (3–12)	0.389
Drainage (mL)^b	12.5 (2–60)	15 (5–60)	0.989
Duration of operation (min)^a	64.9±17.2	57.2±15.8	0.021

Notes: ^aExhibited in the format of “Mean ± standard deviation” and tested by Student’s t-test. ^bExhibited in the format of “Median (Min-Max)” and tested by Mann–Whitney U-test.

Table 3 The Preoperative and Postoperative NRS Data

Group	Before Treatment	Post Operation
		1 Week	3 Month	6 Month	12 Month
A (calcified)^a	7.3±1.3	2.3±0.8	2.1±0.8	1.2±0.8	1.0±0.6
B (non- calcified)^a	7.2±0.9	2.1±1.5	1.9±0.9	1.0±0.9	0.9±0.8
P-value	0.651	0.475	0.159	0.253	0.533

Note: ^aExhibited in the format of “Mean ± standard deviation” and tested by Student’s t-test.

Figure 4 ODI scores in groups A and B. Blue is group A, red is group B. The ODI score of group A was expressed as mean ± standard deviation. In the preoperative and postoperative 1 week, after 3 months, 6 months after operation, and postoperative 12 months were 67.4% ± 13.3%, 32.0%± 9.0%, and 20.4% ± 8.8%, 11.0% ± 6.3%, and 6.8% ± 5.2%. The ODI score of group B was expressed as mean ± standard deviation. In the preoperative and postoperative 1 week, after 3 months, 6 months after operation, and postoperative 12 months were 67.7%±14.4%, 31.1%±10.8%, 19.6%±7.8%, 10.7%±5.8%, 5.9%±5.4%.

Figure 5 Modified Macnab criteria. (A) Modified Macnab criteria of group A. (B) Modified Macnab criteria of group B.

Figure 6 Preoperative CT and MRI images. Preoperative sagittal (A) and axial (B) views by computed tomography. Preoperative sagittal (C) and axial (D) views by magnetic resonance imaging. The calcified lumbar disc compression nerve is indicated by the white arrow and white circle. The patient was a 70-year-old woman with preoperative CT and MRI showing a calcified lumbar disc herniation with nerve compression.The white arrows and circles indicate the location of the calcification foci pressing on the nerve root.

Figure 7 Postoperative CT and MRI images. Postoperative sagittal (A) and axial (B) views by computed tomography. Postoperative sagittal (C) and axial (D) views by magnetic resonance imaging. The position indicated by The white arrow and circle indicates that the vertebral margin to which the calcified lesion was attached was removed by casing rotation. The patient’s pain was improved after surgery compared with that before surgery, and the compression site obtained sufficient decompression.