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

Ajay Krishnan; Chandhan Murugan; Mikeson Panthackel; Abhijith Anil; Devanand Degulmadi; Shivanand Mayi; Ravi Ranjan Rai; Mirant B Dave; Mrugank Narvekar; Rohan Killekar; Preety Ajay Krishnan; Bharat R Dave

doi:10.1016/j.wneu.2024.03.104

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

World Neurosurg. 2024 Mar 24:S1878-8750(24)00489-3. doi: 10.1016/j.wneu.2024.03.104. Online ahead of print.

Affiliations

¹ Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Department of Spine Surgery, Bhavnagar Institute of Medical Science, Bhavnagar, Gujarat, India. Electronic address: drajaykrishnan@gmail.com.
² Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India.
³ Department of Radiodiagnosis, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India.
⁴ Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Gujarat University, Ahmedabad, Gujarat, India.

PMID: 38531475
DOI: 10.1016/j.wneu.2024.03.104

Abstract

Background: Calcified lumbar disc herniations (CLDH) causing calcified ventral stenosis pose a therapeutic challenge to the treating surgeon due to their neural adhesions, location, and hardness.

Methods: This retrospective study analyzed all the cases of CLDH/calcified ventral stenosis managed by transforaminal endoscopic lumbar discectomy with a minimum follow-up of 24 months. The preoperative images were analyzed for the level, migration; and grade (Lee's migration zones), and location (Michigan State University classification). Detailed surgical technique and intraoperative parameters including the duration of surgery and complications have been recorded. The clinical parameters including visual analog scale (VAS), Oswestry disability index (ODI), length of stay in hospital, days of return to basic work, and patient satisfaction index were analyzed. Postoperatively the images were analyzed for the adequacy of decompression.

Results: The 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 preoperative ODI was 78.2 ± 13.2 (63.2-95.6). Nineteen patients (24%) had neurological deficits preoperatively. The mean duration of surgery was 90.5 ± 15.8 (58-131) minutes. Postoperative magnetic resonance imaging revealed adequate decompression in 97.5% (n = 77). The mean duration of hospital stay was 1.05 ± 0.22 (1-2) days, and the postoperative 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), respectively. 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 patient satisfaction index was 1.18 ± 0.47 (1-2) at a mean follow-up of 5.52 ± 2.91 (2-12.75) years.

Conclusions: Transforaminal endoscopic lumbar discectomy is a complete, safe, and efficacious procedure in patients with CLDH with earlier recovery considering the surgery is performed with the patient being awake.

Keywords: Calcified stenosis; Decompression; Disc; Full endoscopy; Herniation; Lumbar; Prolapse; Spine; Transforaminal; ventral.