Zhang Yaoshen, Ding Zihao, Wang Jie, Guan Li, Liu Yuzeng, Hai Yong
Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
, Joint Laboratory for Research & Treatment of Spinal Cord Injury in SpinalDeformity, Capital Medical University, China.
Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06577-2.
Unilateral biportal endoscopy (UBE) is a predominantly minimally invasive surgical technique for addressing LDH. Nonetheless, recurrent lumbar disc herniation (rLDH) remains the predominant reason for reoperation following UBE. This retrospective study examined the risk factors and reoperation rates for rLDH following UBE. This study aimed to examine the risk factors associated with rLDH and the reoperation rate after single-level UBE.
We retrospectively analyzed 205 patients who underwent UBE for single-level LDH from 2019 to 2023 to determine reoperation causes and related risk variables. Reoperation was characterized as the postoperative radiological evidence of persistent symptomatic disc herniation at the same level, necessitating further surgical intervention. We gathered radiographic and demographic parameters preoperatively and postoperatively. Patients with recurrent LDH had additional evaluation during recurrence and revision operations.
Of the 205 patients, 21 (10.2%) required further rLDH revision surgery. The multivariate analysis indicated that obesity and elevated fasting blood glucose (FBG) levels were independent risk variables with strong predictive value for reoperation after controlling for other potential risk factors. Based on the receiver operating characteristic curve analysis, the cutoff points for UBE were body mass index (BMI) = 25.775 kg/m and FBG = 5.155 mmol/L.
This study identified obesity (BMI > 25.775 kg/m²) and elevated FBG levels (> 5.155 mmol/L) as independent risk factors for UBE reoperation. Hence, we recommend longer rehabilitation interventions, such as wearing a suitable brace and strengthening the paraspinal muscles, for patients with obesity and high FBG who undergo UBE.
单侧双通道内镜技术（UBE）是一种主要用于治疗腰椎间盘突出症（LDH）的微创手术技术。尽管如此，复发性腰椎间盘突出症（rLDH）仍然是UBE术后再次手术的主要原因。本回顾性研究探讨了UBE术后rLDH的危险因素及再次手术率。本研究旨在探讨与rLDH相关的危险因素以及单节段UBE术后的再次手术率。
我们回顾性分析了2019年至2023年期间接受单节段LDH的UBE手术的205例患者，以确定再次手术的原因及相关风险变量。再次手术的定义为术后影像学显示同一节段存在持续有症状的椎间盘突出，需要进一步手术干预。我们收集了术前和术后的影像学及人口统计学参数。复发性LDH患者在复发和翻修手术期间进行了额外评估。
205例患者中，21例（10.2%）需要进行rLDH翻修手术。多因素分析表明，在控制其他潜在危险因素后，肥胖和空腹血糖（FBG）水平升高是具有较强预测价值的再次手术独立风险变量。根据受试者工作特征曲线分析，UBE的截断点为体重指数（BMI）=25.775kg/m²和FBG=5.155mmol/L。
本研究确定肥胖（BMI>25.775kg/m²）和FBG水平升高（>5.155mmol/L）是UBE再次手术的独立危险因素。因此，我们建议对接受UBE手术的肥胖和高FBG患者进行更长时间的康复干预，如佩戴合适的支具和加强椎旁肌锻炼。
