The First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, China (mainland).
Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland).
Med Sci Monit. 2023 Aug 15;29:e939844. doi: 10.12659/MSM.939844.
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has gained popularity as a minimally invasive surgery for treating lumbar disc herniation. However, there is limited research focusing on the reoperation rate and its associated factors. This study aims to investigate the rate of reoperation and identify the causes and risk factors for reoperation after PELD. MATERIAL AND METHODS We conducted a retrospective analysis of patients who underwent PELD (interlaminar and transforaminal approaches) at our hospital from November 2016 to May 2020. A matched case-control design was employed to identify relevant risk factors for reoperation, with a matching ratio of 1:3. Clinical characteristics and radiological parameters were compared, and univariate analysis was performed using independent samples t-test and chi-squared test. RESULTS Among the 435 patients included in the study, the reoperation rate for those with a minimum 2-year follow-up was 6.2% (27/435). The causes of reoperation and their respective rates were as follows: recurrence of lumbar disc herniation (3.2%, 14/435), incomplete decompression (1.8%, 8/435), persistent low back pain (0.7%, 3/435), and postoperative infection (0.5%, 2/435). Univariate analysis revealed that age (P=0.015), Pfirrmann grade IV-V (P=0.017), and lack of active straight leg raise exercises (P=0.026) were significantly associated with reoperation. Multiple logistic regression analysis indicated that age (P=0.001), Pfirrmann grade IV-V (P=0.033), and lack of active straight leg raise exercises postoperatively (P=0.003) were independent risk factors for reoperation after PELD. CONCLUSIONS The primary cause of reoperation in lumbar disc herniation patients after PELD was recurrence of the herniation. Additionally, severe disc degeneration, older age, and lack of active straight leg raise exercises were identified as significant risk factors associated with an increased reoperation rate.
经皮内镜腰椎间盘切除术（PELD）作为一种治疗腰椎间盘突出症的微创方法已越来越受欢迎。然而，针对 PELD 术后再手术率及其相关因素的研究较少。本研究旨在探讨 PELD 术后再手术率，并确定 PELD 术后再手术的原因和危险因素。
我们对 2016 年 11 月至 2020 年 5 月在我院行 PELD（经皮椎间孔入路和经皮侧方入路）的患者进行回顾性分析。采用病例对照研究设计，匹配再手术率的相关危险因素，匹配比例为 1:3。比较临床特征和影像学参数，采用独立样本 t 检验和卡方检验进行单因素分析。
在纳入的 435 例患者中，对随访时间至少 2 年的患者进行再手术率分析，其再手术率为 6.2%（27/435）。再手术的原因及其发生率如下：腰椎间盘突出症复发（3.2%，14/435）、减压不彻底（1.8%，8/435）、持续性腰痛（0.7%，3/435）、术后感染（0.5%，2/435）。单因素分析显示，年龄（P=0.015）、Pfirrmann 分级 IV-V 级（P=0.017）和术后未行直腿抬高运动（P=0.026）与再手术显著相关。多因素逻辑回归分析表明，年龄（P=0.001）、Pfirrmann 分级 IV-V 级（P=0.033）和术后未行直腿抬高运动（P=0.003）是 PELD 术后再手术的独立危险因素。
腰椎间盘突出症患者 PELD 术后再手术的主要原因为椎间盘突出复发。此外，严重的椎间盘退变、年龄较大和术后未行直腿抬高运动是 PELD 术后再手术率增加的显著危险因素。
