| BackgroundSince Percutaneous Endoscopic Lumbar Discectomy(PELD)was applied to treat lumbar disc herniation,its safety and effectiveness have been widely recognized.Compared with open surgery,PELD has many advantages,such as minimal trauma,however,the reoperations after PELD are still a huge challenge for spine surgeons.As far as risk factors are concerned,demographic factors and imaging factors are included in various studies,but they still remained controversial.ObjectiveThe study was conducted to determine the risk factors of reoperations for lumbar disc herniation after percutaneous endoscopic lumbar discectomy by analyzing the clinical characteristics of reoperation patients,so as to provide reference for the selection of patients for primary PELD.MethodsThe 512 patients who underwent PELD for single-level LDH between July 2014 to December 2017 were enrolled in this study.Surgical findings(age?sex?body mass index(BMI)?smoking?diabetes?course of disease?operation time and surgeons)and clinical parameters(herniation type,Pfirrmann disc degeneration grade,Modic endplate changes,disc height,unherniated disc calcification,lumbar instability)were collected and retrospectively assessed.The factors above were compared between the two groups using unpaired t test?Chi-Square test and Nonparametric test.Variables that were significant at the P<0.1 level were candidates for inclusion in the final multivariable logistic regression analysis.The risk factors that were at the P<0.05 level were recepted.Results(1)In the reoperation group,there were 41 patients,including 29(70.7%)males and 12 females(29.3%),with an average age of 47.10+16.72 years(16-82 years).There were 24 cases with L4/5,17 cases with L5/S1.In the non-reoperation group,there were 471 patients,including 285(60.5%)males and 186(39.5%)females,with an average age of 43.39±14.90 years old(16-87 years).There were 2 cases with L2/3,15 cases with L3/4,226 cases with L4/5,269 cases with L5/S1.(2)Clinical characteristics of reoperation patients:41 patients underwent reoperation,included L4/5(58.5%)and L5/S1(41.5%).The causes of reoperation included persistent or recurrent low back and leg pain(27 cases,65.9%),lumbar spinal stenosis or spondylolisthesis(7 cases,17.1%),other segmental herniation(5 cases,12.2%),contralateral protrusion of operative segments and cyst of intervertebral disc(1 case,2.4%)respectively.Of the reoperated patients,there were 25 for PELD,2 for microendoscopic diskectomy(MED)and 14 for transforaminal lumbar interbody fusion(TLIF).(3)Reoperation rate:The average interval between the two operations was 12.15±8.77 months(1-44 months).65.9%of the revision operations(27 cases)were performed within one year after the primary operation.The cumulative overall reoperation rate at 6m?12m?24m was 1.2%,2.1%and 4.3%respectively,and gradually increased to 10.4%in 54 months.Univariate analysis:The demographic characteristics and clinical data before PELD showed that there were significant differences between the two groups in age(?50 years old)(51.2%vs 33.7%),BMI(>24Kg/m2)(58.5%vs 42.2%),lumbar instability(48.8%vs 34.0%)and unherniated disc calcification(14.6%vs 33.8%)(P<0.1).However,the differences in gender,smoking history and disc height between the two groups was not significant(P>0.1).Multivariate logistic regression:BMI>24Kg/m2(OR 2.14,95%CI1.100-4.15)seemed to be the most important risk factor for reoperations after PELD to treat LDH and unherniated disc calcification may be a protective factor(OR 0.36 95%CI0.153-0.844),P<0.05?ConclusionPercutaneous endoscopic lumbar discectomy(PELD)is an important treatment for lumbar disc herniation,but reoperations may not avoided.The cumulative reoperation rate in 54 months was about 10.4%,and 65.9%reoperation occured within one year.Preoperative overweight or obesity,elderly,lumbar instability patients should be carefully assessed for PELD.Unherniated disc calcification may be a protective factor for reoperation,but larger clinical data and onger follow-up data were needed to prove it. |
PDF Full Text Request