https://orcid.org/0000-0002-1466-9667
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Abstract
Background
Percutaneous endoscopic lumbar discectomy (PELD) is an increasingly applied minimally invasive procedure that has several advantages in the treatment of lumbar disc herniation (LDH). However, recurrent LDH (rLDH) has become a concerning postoperative complication. It remains difficult to establish a consensus and draw reliable conclusions regarding the risk factors for rLDH.
Purpose
This retrospective study aimed to investigate the risk factors associated with rLDH at the L4-5 level after percutaneous endoscopic transforaminal discectomy (PETD).
Methods
A total of 654 patients who underwent the PETD procedure at the L4-5 level from October 2013 to January 2020 were divided into a recurrence (R) group (n=46) and a nonrecurrence (N) group (n=608). Demographic and clinical data and imaging parameters were collected and analyzed using univariate and multiple regression analyses.
Results
The current study found a 7% rate of rLDH at the L4/5 level after successful PETD. Univariate analysis showed that older age, high BMI, diabetes mellitus history, smoking, large physical load intensity, moderate disc degeneration, small muscle–disc ratio (M/D), more fat infiltration, large sagittal range of motion (sROM), scoliosis, small disc height index (DHI), small intervertebral space angle (ISA), and small lumbar lordosis (LL) were potential risk factors (P < 0.10) for LDH recurrence after PETD at the L4-5 level. Multivariate analysis suggested that high BMI, large physical load intensity, moderate disc degeneration, small M/D, more fat infiltration, large sROM, small ISA, and small LL were independent significant risk factors for recurrence of LDH after PETD.
Conclusion
Consideration of disc degeneration, M/D, fat infiltration of the paravertebral muscles, sROM, ISA, LL, BMI, and physical load intensity prior to surgical intervention may contribute to the prevention of rLDH following PETD and lead to a more satisfactory operative outcome and the development of a reasonable rehabilitation program after discharge.
Acknowledgments
This work was supported by grants from the National Natural Science Foundation of China (81672200, 81871804 and National Key Research and Development Project (CN) (2019YFC0121400). We are grateful to the Orthopedic Medical Center of the Affiliated Hospital of Qingdao University and the special procedures team.
Meng Kong and Derong Xu should be considered as co-first authors.
Ethics and Consent
All procedures were performed in compliance with the Declaration of Helsinki and were approved by the Ethics Committee of the Affiliated Hospital of Qingdao University. All patients involved gave written informed consent to review their medical records. All personal details were erased before analysis to cover patient data confidentiality.
Disclosure
The authors declare no relevant financial, personal, political, intellectual or religious conflicts of interests for this work.