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Risk Factors for Recurrent L4-5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A
Meng Kong1,2, Derong Xu1, Changtong Gao3
1Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.
Risk Management and Healthcare Policy
|December 30, 2020
Summary
Recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic transforaminal discectomy (PETD) affects 7% of patients. Key risk factors include high BMI, moderate disc degeneration, and reduced muscle quality, guiding preventative strategies.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Neurosurgery
Background:
- Percutaneous endoscopic lumbar discectomy (PELD) offers advantages for lumbar disc herniation (LDH).
- Recurrent LDH (rLDH) is a significant postoperative complication.
- Identifying rLDH risk factors after PELD is crucial but challenging.
Purpose of the Study:
- To investigate risk factors for recurrent lumbar disc herniation (rLDH).
- Focus on patients undergoing percutaneous endoscopic transforaminal discectomy (PETD) at the L4-5 level.
Main Methods:
- Retrospective analysis of 654 patients undergoing PETD at L4-5 (October 2013 - January 2020).
- Patients divided into recurrence (n=46) and non-recurrence (n=608) groups.
- Analysis of demographic, clinical, and imaging data using univariate and multiple regression.
Main Results:
- The study identified a 7% rLDH rate after PETD at L4-5.
- Univariate analysis revealed multiple potential risk factors (e.g., age, BMI, smoking, degeneration, muscle quality, ROM, spinal alignment).
- Multivariate analysis confirmed independent risk factors: high BMI, high physical load, moderate disc degeneration, small muscle-disc ratio, fat infiltration, large sROM, small ISA, and small LL.
Conclusions:
- Preoperative assessment of disc degeneration, muscle quality (M/D, fat infiltration), spinal mobility (sROM), alignment (ISA, LL), BMI, and physical load is important.
- Considering these factors may help prevent rLDH after PETD.
- This approach can lead to better surgical outcomes and inform rehabilitation programs.
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