Abstract
Purpose
To investigate radiological risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous transforaminal endoscopic discectomy (PTED).
Methods
Patients who underwent PTED due to a single-level L4-L5 or L5-S1 disc herniation from January 2013 to May 2019 were enrolled in this study. A matched case-control design was carried out in a single institution. Cases were defined as those who developed rLDH, and controls were matched from those patients without rLDH according to corresponding clinical characteristics. The radiological parameters were compared between two groups. The radiological risk factors for rLDH after PTED were identified by univariate and multivariate logistic regression analysis.
Results
A total of 2186 patients who underwent PTED at L4-L5 or L5-S1 level were enrolled in this study. Sixty-eight patients were diagnosed with rLDH, and 136 patients were selected from the remaining 2118 nonrecurrent patients as matched controls. Univariate analysis demonstrated that herniation type (P = 0.009), surgical-level disc degeneration (P < 0.001), adjacent-level disc degeneration (P = 0.017), disc height index (DHI) (P = 0.003), and sagittal range of motion (sROM) (P < 0.001) were significantly related to rLDH. Multiple logistic regression analysis showed that low grade of surgical-level disc degeneration (P < 0.001), senior grade of adjacent-level disc degeneration (P < 0.001), a high DHI (P = 0.012), and a large sROM (P < 0.001) were the radiological independent risk factors.
Conclusion
This study showed that low grade of surgical-level disc degeneration, senior grade of adjacent-level disc degeneration, a high DHI, and a large sROM were the radiological independent risk factors for rLDH after PTED.
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References
Choi KC, Lee JH, Kim JS et al (2015) Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery 76:372–381
Yao Y, Liu H, Zhang H et al (2017) Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy. World Neurosurg 100:1–6
Yurac R, Zamorano JJ, Lira F et al (2016) Risk factors for the need of surgical treatment of a first recurrent lumbar disc herniation. Eur Spine J 25:1403–1408
Miwa S, Yokogawa A, Kobayashi T et al (2015) Risk factors of recurrent lumbar disc herniation: a single center study and review of the literature. J Spinal Disord Tech 28:E265–E269
Kim KT, Park SW, Kim YB (2009) Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine 34:2674–2678
Kim KT, Lee DH, Cho DC et al (2015) Preoperative risk factors for recurrent lumbar disc herniation in L5-S1. J Spinal Disord Tech 28:E571–E577
Kim HS, You JD, Ju CI (2019) Predictive scoring and risk factors of early recurrence after percutaneous endoscopic lumbar discectomy. Biomed Res Int 2019:6492675
Leven D, Passias PG, Errico TJ et al (2015) Risk factors for reoperation in patients treated surgically for intervertebral disc herniation: a subanalysis of eight-year SPORT data. J Bone Joint Surg Am 97:1316–1325
Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878
Yu LP, Qian WW, Yin GY et al (2012) MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the pfirrmann grading systems. PLoS ONE 7:e48074
Liu Z, Duan Y, Rong X et al (2017) Variation of facet joint orientation and tropism in lumbar degenerative spondylolisthesis and disc herniation at L4-L5: a systematic review and meta-analysis. Clin Neurol Neurosurg 161:41–47
Yin S, Du H, Yang W et al (2018) Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a meta-analysis. Pain Physician 21:337–350
Kim JM, Lee SH, Ahn Y et al (2007) Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50:82–85
Morgan-Hough CV, Jones PW, Eisenstein SM (2003) Primary and revision lumbar discectomy. a 16-year review from one centre. J Bone Joint Surg Br 85:871–874
Kim MS, Park KW, Hwang C et al (2009) Recurrence rate of lumbar disc herniation after open discectomy in active young men. Spine 34:24–29
Dora C, Schmid MR, Elfering A et al (2005) Lumbar disc herniation: do MR imaging findings predict recurrence after surgical diskectomy? Radiology 235:562–567
Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop Relat Res 165:110–123
Bible JE, Simpson AK, Emerson JW et al (2008) Quantifying the effects of degeneration and other patient factors on lumbar segmental range of motion using multivariate analysis. Spine 33:1793–1799
Hasegawa K, Kitahara K, Hara T et al (2008) Evaluation of lumbar segmental instability in degenerative diseases by using a new intraoperative measurement system. J Neurosurg Spine 8:255–262
Fujiwara A, Lim TH, An HS et al (2000) The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine 25:3036–3044
Tanaka N, An HS, Lim TH et al (2001) The relationship between disc degeneration and flexibility of the lumbar spine. Spine J 1:47–56
Schleich C, Müller-Lutz A, Blum K et al (2016) Facet tropism and facet joint orientation: risk factors for the development of early biochemical alterations of lumbar intervertebral discs. Osteoarthr Cartil 24:1761–1768
Li Z, Yang H, Liu M et al (2018) Clinical characteristics and risk factors of recurrent lumbar disc herniation: A retrospective analysis of three hundred twenty-one cases. Spine 43:1463–1469
Yao Y, Liu H, Zhang H et al (2016) Risk factors for the recurrent herniation after microendoscopic discectomy. World Neurosurg 95:451–455
Mok FP, Samartzis D, Karppinen J et al (2016) Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J 16:32–41
Funding
This study was funded by the Graduate Student Scientific Research Innovation Projects of Jiangsu Province (KYCX18_0176) and the Fundamental Research Funds for the Central Universities (2242019K40257).
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Hang Shi and Lei Zhu contributed equally to this study.
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Shi, H., Zhu, L., Jiang, ZL. et al. Radiological risk factors for recurrent lumbar disc herniation after percutaneous transforaminal endoscopic discectomy: a retrospective matched case-control study. Eur Spine J 30, 886–892 (2021). https://doi.org/10.1007/s00586-020-06674-3
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DOI: https://doi.org/10.1007/s00586-020-06674-3