Kong Meng, Xu Derong, Gao Changtong, Zhu Kai, Han Shuo, Zhang Hao, Zhou Chuanli, Ma Xuexiao
Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.
Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.
Risk Manag Healthc Policy. 2020 Dec 18;13:3051-3065. doi: 10.2147/RMHP.S287976. eCollection 2020.
Percutaneous endoscopic lumbar discectomy (PELD) is an increasingly applied minimally invasive procedure that has several advantages in the treatment of lumbar disc herniation (LDH). However, recurrent LDH (rLDH) has become a concerning postoperative complication. It remains difficult to establish a consensus and draw reliable conclusions regarding the risk factors for rLDH.
This retrospective study aimed to investigate the risk factors associated with rLDH at the L4-5 level after percutaneous endoscopic transforaminal discectomy (PETD).
A total of 654 patients who underwent the PETD procedure at the L4-5 level from October 2013 to January 2020 were divided into a recurrence (R) group (n=46) and a nonrecurrence (N) group (n=608). Demographic and clinical data and imaging parameters were collected and analyzed using univariate and multiple regression analyses.
The current study found a 7% rate of rLDH at the L4/5 level after successful PETD. Univariate analysis showed that older age, high BMI, diabetes mellitus history, smoking, large physical load intensity, moderate disc degeneration, small muscle-disc ratio (M/D), more fat infiltration, large sagittal range of motion (sROM), scoliosis, small disc height index (DHI), small intervertebral space angle (ISA), and small lumbar lordosis (LL) were potential risk factors (P < 0.10) for LDH recurrence after PETD at the L4-5 level. Multivariate analysis suggested that high BMI, large physical load intensity, moderate disc degeneration, small M/D, more fat infiltration, large sROM, small ISA, and small LL were independent significant risk factors for recurrence of LDH after PETD.
Consideration of disc degeneration, M/D, fat infiltration of the paravertebral muscles, sROM, ISA, LL, BMI, and physical load intensity prior to surgical intervention may contribute to the prevention of rLDH following PETD and lead to a more satisfactory operative outcome and the development of a reasonable rehabilitation program after discharge.
经皮内镜下腰椎间盘切除术（PELD）是一种应用日益广泛的微创手术，在治疗腰椎间盘突出症（LDH）方面具有诸多优势。然而，复发性腰椎间盘突出症（rLDH）已成为一个令人担忧的术后并发症。关于rLDH的危险因素，目前仍难以达成共识并得出可靠结论。
本回顾性研究旨在探讨经皮内镜下椎间孔入路椎间盘切除术（PETD）后L4-5节段rLDH的相关危险因素。
将2013年10月至2020年1月期间在L4-5节段接受PETD手术的654例患者分为复发组（R组，n=46）和非复发组（N组，n=608）。收集人口统计学和临床数据以及影像学参数，并采用单因素和多元回归分析进行分析。
本研究发现PETD成功后L4/5节段rLDH发生率为7%。单因素分析显示，年龄较大、体重指数（BMI）较高、有糖尿病史、吸烟、体力负荷强度大、椎间盘中度退变、肌肉-椎间盘比值（M/D）小、脂肪浸润较多、矢状面活动度（sROM）大、脊柱侧弯、椎间盘高度指数（DHI）小、椎间孔角度（ISA）小以及腰椎前凸（LL）小是PETD后L4-5节段LDH复发的潜在危险因素（P<0.10）。多因素分析表明，BMI较高、体力负荷强度大、椎间盘中度退变、M/D小、脂肪浸润较多、sROM大、ISA小以及LL小是PETD后LDH复发的独立显著危险因素。
在手术干预前考虑椎间盘退变、M/D、椎旁肌脂肪浸润、sROM、ISA、LL、BMI和体力负荷强度，可能有助于预防PETD后的rLDH，并带来更满意的手术效果以及制定出院后合理的康复计划。
