Analysis Of Factors Influencing Recurrence Of Lumbar Disc Herniation After Endoscopic Surgery

Objective: to retrospectively analyze the postoperative recurrence rate and related factors of lumbar disc herniation treated by percutaneous intervertebral foramen approach and interlamellar space approach Design type: retrospective study Location: department 1 of spine,hospital of traditional Chinese medicine,xinjiang uygur autonomous region Study subjects: from June 2015 to December 2016,a total of 218 patients with lumbar disc herniation were treated with endoscopy through the intervertebral foramen approach or lamina gap approach,including 106 males and 112 females,aged 18-86 years,and followed up for 24-40 months.The patients were divided into recurrence group and non-recurrence group according to the follow-up periodMethods: visual pain analogue scale(VAS)and Japanese orthopaedic association lumbar spine function score(JOA)were used to evaluate the therapeutic effect.Single-factor analysis was used to analyze the recurrence and age,gender,ethnic group,occupation,body weight,Modic change,intervertebral space height,sagittal activity,lesion segment,approach method,grade of disc degeneration,type of herniation,perioperative rehabilitation,VAS score difference,JOA score improvement rate.Logistic regression analysis was used to analyze the relevant factors with statistical differences and clinical significanceResults: a total of 12 patients relapsed during the follow-up period,9 of whom received reoperation.The recurrence time was 1-9 months after operation.Single-factor analysis showed that Modic sign,JOA score improvement rate and VAS score difference were all the influencing factors of recurrence(P < 0.05).In addition,we considered that perioperative acupuncture therapy also had an impact on postoperative recurrence of lumbar disc herniation,so the above three factors combined with perioperative rehabilitation mode were included in the multi-factor analysis model.Multivariate analysis showed that the difference between JOA score improvement rate and VAS score was the protective factor for recurrence,and the regression coefficient of JOA score improvement rate was-3.964,which was the strongest protective factor.Modic change was an independent risk factor,and the postoperative recurrence rate of patients with Modic change was 6.7 times that of patients without Modic changeConclusion: a total of 12 patients relapsed within 2 years after surgery,with a recurrence rate of 5.5%.The recurrence time was 1-9 months after operation.The higher the JOA score improvement rate and VAS score difference are,the less likely they are to relapse.Perioperative acupuncture treatment may reduce the risk of recurrence.Patients with Modic alteration have high recurrence probability,which is an independent risk factor.