Risk Factors For Postoperative Recurrence Of Lumbar Disc Herniation Treated By Percutaneous Endoscopic Lumbar Discectomy

Objective:Through the retrospective study of the patients with postoperative recurrence of lumbar disc hemiation(LDH)treated by percutaneous endoscopic lumbar discectomy(PELD),the clinical efficacy will be discussed.And the risk factors that may lead to postoperative recurrence will be analyzed,so as to provide theoretical basis for improving the technique and guiding the recovery,and reduce the postoperative recurrence rate.Methods:From Sept.2015 to Sept.2018,26 cases of LDH patients treated by PELD and showing recurrence at least 3 months after the operation are selected as the observation group,including 15 males and 11 females.The age of observation group is from 34 to 71 Y/O.,with an average of 50.88 Y/O.,and the duration of the disease is from 3 to 120 months,with an average of 27.46 months.102 cases without recurrence are selected as the control group,including 62 males and 40 females.The age of control group is from 19 to 68 Y/O.,with an average of 43.58 Y/O.,and the duration of the disease is from 2 to 96 months,with an average of 13.11 months.Clinical efficacy will be assessed by Visual Analogue System(VAS)and the Japanese Orthopaedic Association(JOA)scores of lumbar spine with a total of 29 points.The observation indexes of risk factors include general situation,incidence,operative segment,postoperative working intensity,imaging data,etc.,with a total of 12 categories and 37 items.The obtained data were calculated and analyzed through statistical software to detennine the risk factors and independent risk factors that may lead to postoperative recurrence of PELD.Results:The preoperative VAS scores of the two groups are reduced from(6.85±1.12)and(6.961l.19)to(1.65±0.89)and(1.56±0.79)three days after surgery respectively,while the VAS scores of the control group are only(0.97±0.76)at the last follow-up.The improvement rate of JOA scores in both groups is about 40%three days after surgery,while the improvement rate of JOA scores in the control group is 83.27%±14.32%at the last follow-up.By univariate analysis,the age(P=0.002),duration of disease(P=0.009)and postoperative working intensity(P=0.001)of both groups are statistically significant(P<0.05),indicating that the above three items are risk factors for postoperative recurrence of PELD.Logistic regression analysis showed that age and postoperative working intensity are independent risk factors for postoperative recurrence of PELD.Referring to the<50 Y/O.group,the>50 Y/O.group[OR=5.490(95%CI:1.847,16.319),P=0.002].Referring to the non-fatigue group,the sedentary group[ORF=12.668(95%CI:1.078,148.905),P=0.043]and the heavy working group[OR=96.170(95%CI:3.995,2315.239),P=0.005].The postoperative working intensity is the main influencing factor of the independent risk factors.The duration of disease(P>0.05)is not the independent risk factor for postoperative recurrence of PELD.Conclusion:The clinical efficacy of PELD in the treatment of LDH is reliable,but postoperative recurrence should be paid enough attention.The factors causing postoperative recurrence are various and interplay with each other.Corresponding preventive measures should be taken in clinical practice to effectively improve the efficacy of surgery and reduce the probability of postoperative recurrence.