Zhang Kai, Tang Yingchuang, Li Hanwen, Peng Peng, Ruan Xingbang, Zhen Xiangyan, Meng Bin, Yang Huilin, Zhang Junxin, Mao Haiqing, Chen Kangwu
Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Orthop Surg. 2025 Aug 27. doi: 10.1111/os.70152.
Calcified lumbar disc herniation (CLDH) is one specific type of lumbar disc herniation (LDH). Currently, there are no uniform classification standards for different calcification degrees of herniated lumbar disc tissue. Percutaneous endoscopic interlaminar discectomy (PEID) has been proved to exhibit great efficacy in treating LDH, but whether it can achieve satisfactory results in treating CLDH with different calcification remains unclear.
A total of 271 patients who suffered from single CLDH (97 patients) or NCLDH (non-calcified lumbar disc herniation) who received PEID surgery between January 2016 and December 2018 in our hospital participated in this retrospective study. Moreover, CLDH was divided into four grades based on preoperative sagittal CT images, including 34 Grade I, 22 Grade II, 19 Grade III, and 22 Grade IV. Operative time was evaluated between the two groups. In addition, VAS (leg pain), ODI, and MacNab scale score were applied to assess the efficacy of PEID in treating CLDH with different calcification degrees by Student's t tests or χ test.
All the patients successfully underwent PEID surgery. According to the analysis, the operative time in the CLDH group was significantly longer than that in NCLDH group. Preoperative and postoperative VAS (leg pain) and ODI scores have no significant differences between the CLDH and NCLDH groups. Furthermore, postoperative modified MacNab scale scores and complication rates were almost the same in the two groups. However, there were some differences in terms of VAS (leg pain), ODI, and MacNab scores during LDH patients with different degrees of calcification. CLDH was divided into four grades in our study, and the analysis displayed that VAS (leg pain) and ODI scores after operation in the Grade IV CLDH group were both obviously higher than those in the control group. Moreover, the modified MacNab scale showed that excellent or good rates in the Grade IV CLDH group (73%) were lowest, and they were significantly lower than those in the control group (91%). The other statistical indexes such as recurrence and complication rates showed no significant difference in CLDH with different degrees of calcification.
CLDH was innovatively divided into four grades in our study. PEID is an effective and safe surgical method for treating CLDH; it can achieve a satisfactory outcome. However, it should be considered carefully in the treatment of lumbar disc herniation with severe calcification (Grade IV).
钙化型腰椎间盘突出症（CLDH）是腰椎间盘突出症（LDH）的一种特殊类型。目前，对于腰椎间盘突出组织不同钙化程度尚无统一的分类标准。经皮内镜下椎间孔切开椎间盘切除术（PEID）已被证明在治疗LDH方面疗效显著，但对于不同钙化程度的CLDH能否取得满意疗效仍不清楚。
2016年1月至2018年12月期间在我院接受PEID手术的271例单节段CLDH患者（97例）或非钙化型腰椎间盘突出症（NCLDH）患者参与了这项回顾性研究。此外，根据术前矢状位CT图像将CLDH分为四级，包括I级34例、II级22例、III级19例和IV级22例。评估两组的手术时间。另外，采用视觉模拟评分法（VAS，腿痛）、腰椎功能障碍指数（ODI）和MacNab量表评分，通过Student's t检验或χ检验评估PEID治疗不同钙化程度CLDH的疗效。
所有患者均成功接受了PEID手术。分析显示，CLDH组的手术时间明显长于NCLDH组。CLDH组和NCLDH组术前和术后VAS（腿痛）及ODI评分无显著差异。此外，两组术后改良MacNab量表评分和并发症发生率几乎相同。然而，不同钙化程度的LDH患者在VAS（腿痛）、ODI和MacNab评分方面存在一些差异。在本研究中CLDH分为四级，分析显示IV级CLDH组术后VAS（腿痛）和ODI评分均明显高于对照组。此外，改良MacNab量表显示IV级CLDH组的优良率（73%）最低，且显著低于对照组（91%）。其他统计指标如复发率和并发症发生率在不同钙化程度的CLDH中无显著差异。
本研究创新性地将CLDH分为四级。PEID是治疗CLDH的一种有效且安全的手术方法；可以取得满意的效果。然而，对于严重钙化（IV级）的腰椎间盘突出症患者，在治疗时应谨慎考虑。
