A Study of Unilateral Biportal Endoscopic Discectomy and Transforaminal Endoscopic Discectomy for Single-level Calcified Lumbar Disc Herniation

Summary

This study evaluates the therapeutic outcomes between unilateral biportal endoscopic (UBE) discectomy and percutaneous endoscopic transforaminal discectomy (PETD) for single-level calcified lumbar disc herniation.

Abstract

Calcified lumbar disc herniation (CLDH) presents unique surgical challenges due to its hard texture and frequent adhesion to neural structures. This study compares the efficacy and safety of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic transforaminal discectomy (PETD) in treating single-level CLDH. An analysis was conducted on 107 patients, with 45 undergoing UBE and 62 PETD. Both techniques significantly improved postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores. PETD demonstrated advantages in operative time, blood loss, incision length, and hospital stay, but required more intraoperative fluoroscopy. UBE was associated with higher early postoperative low back pain VAS scores and a higher incidence of dural tears (2 cases), whereas PETD resulted in one case of transient nerve root symptoms.

While both methods effectively decompress neural elements, PETD offers less invasiveness and faster recovery, particularly beneficial for continuous central calcifications, though it demands specialized instruments and greater radiation exposure. UBE provides a broader operative field and familiar instrumentation but involves more tissue dissection. The findings support the use of either technique for CLDH, with selection influenced by lesion characteristics, surgical expertise, and resource availability. Future efforts should focus on standardizing training and indications to expand access to these minimally invasive options, especially in settings where traditional open surgery remains prevalent.

Introduction

Calcified lumbar disc herniation (CLDH) is a degenerative disease of lumbar disc herniation caused by precipitation or conversion of substances in the body into calcium carbonate or other insoluble calcium salt complexes. It often occurs in patients with long-term conservative treatment of lumbar disc herniation, but the specific cause of the formation is not clear^1,2. The calcified protruding disc can occupy the space of the spinal canal and lateral recess, resulting in or aggravating lumbar pain and neurological symptoms of the lower extremities. Due to the hard texture of calcification and poor elasticity, ....

Protocol

This study was approved by the Ethics Committee of the Third Hospital of Hebei Medical University (K-2024-014-1). All patients' data collection was informed in advance, and informed consent was obtained from all subjects.

Study population

Patients with single-level CLDH were included based on the following criteria: 1) diagnosis confirmed by lumbar intervertebral disc CT; 2) presentation of typical symptoms, including low back pain with lower limb radicular pain, numbness, or muscle weakness; 3) failure to improve after a minimum of 3 months of regular conservative therapy. Exclusion criteria w....

Results

Apart from three cases of loss to follow-up, a total of 107 patients were enrolled in the study, including 45 patients with UBE and 62 patients with PETD. Table 1 shows that there is no significant difference in general information between the two groups, including sex, age, BMI, surgical segment, type of calcification, and so on (P ＞ 0.05). Table 2 shows that the amount of intraoperative blood loss, operation time, length of hospital stay, and surgical incision length in the PETD group .......

Discussion

In our study, the quality of life outcomes of patients showed that both UBE and PETD groups had a significant decrease in ODI and VAS scores after operation, which could improve the symptoms of CLDH patients. Compared with the UBE group, the PETD group showed less bleeding, shorter operation time, smaller incision, and shorter hospital stay, but more fluoroscopy times were needed during the operation. No obvious lumbar instability was observed in both groups one year after the operation.

CLDH .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
4-0 or 5-0 Polydioxanone	Shandong Weigao Group Medical Polymer Co. , Ltd.	9270504	Their PDS sutures are typically used for soft tissue approximation and ligation.
Electric grinder	Guizhou Zirui Technology Co. , Ltd.	04-14-08	Grinding removes lamina bone and exposes ligamentum flavum tissue
Endoscope	UninTech	UNTV-076.30.171	WL 171 mm/OD 7.6 mm/30°/ WChD 4.7 mm/2 x IC 1.5 mm
Kerrison Rongeur Forceps	Xi'an Surgical Medical Science and Technology Co. , Ltd.	38049	Used for biting dead bones or repairing bone stumps.
Minimally invasive spinal surgery channel expansion tube	Xi'an Surgical Medical Science and Technology Co. , Ltd.	04-17-13	Used to expand the surgical field of view.
Nerve stripping ion	Xi'an Surgical Medical Science and Technology Co. , Ltd.	04-18-01	Used for stripping or separating nerve root tissue
Periosteal stripping ion	Xi'an Surgical Medical Science and Technology Co. , Ltd.	04-18-01	Used to peel off or separate the periosteum and soft tissue attached to the bone surface.
Plasma Surgical Blade (RF electrode/ablation electrode)	Xi'an Surgical Medical Science and Technology Co. , Ltd.	1798824	Used to ablate soft tissue such as muscle and fascia, or to clot the surface of muscle and nerve tissue
Radiofrequency coagulator	Kai Zhuo	RFS-4000KD	None
Spinal surgery using nerve hooks	Xi'an Surgical Medical Science and Technology Co. , Ltd.	38078	Used in orthopedic surgery to expose the surgical field of view, or to peel, stretch, or occlude nerve roots during orthopedic surgery.
SPSS Statistics for Windows	IBM Corp	version 26.0	None
T-head cannula	UninTech	UNT-II-167989T	7.9 mm × OD 8.9 mm × L168 mm
Trephine	UninTech	UNT-III-177888	7.8 mm × OD 8.8mm × L 171 mm
U-head cannula	UninTech	UNT-II-159010U	9.0 mm × OD 10.2 mm × L151 mm