Pain Physician. 2022 Oct;25(7):E1039-E1045.
ABSTRACT
BACKGROUND: Recurrent LDH (rLDH) is one of the most common causes of unsatisfactory outcomes after discectomy, which usually needs secondary surgery and leads to physical and psychological suffering for patients and substantial costs for society.
OBJECTIVES: This study was conducted to analyze the risk factors of early rLDH (<= 6 months) and to reduce the incidence of early rLDH.
STUDY DESIGN: A clinical retrospective study.
METHODS: A total of 1,228 patients received percutaneous endoscopic lumbar discectomy surgery from January 2013 through December 2016; there was a minimum 5-year follow-up. Seventy-seven of them (6.27%) developed recurrences and were included in this study. According to the differences in recurrent time, patients were divided into 2 groups (<= 6 months and > 6 months). Clinical and radiological parameters were retrospectively collected through chart review and preoperative imaging. All related risk factors were collected and analyzed relative to the time of recurrent herniation.
RESULTS: Patients with rLDH at <= 6 months and > 6 months were 49 and 28, respectively. Recurrence most often occurred within 6 months postoperatively, which was 63.6% of the total patients with rLDH. Of those risk factors, Modic changes, disc height index (DHI), and facet orientation (FO) showed significant statistical differences P = 0.003, P = 0.036, and P = 0.007, respectively). A logistic regression analysis was performed and showed there was an independent significant relationship between Modic changes (P = 0.042) and FO (P = 0.005) and early rLDH.
LIMITATIONS: First, this was a retrospective nonrandomized study, and the number of patients with rLDH included in this study was relatively small. Second, limited risk factors were assessed in this study, and some relevant risk factors that were identified as significant independent predictors in other studies were not included in this study, such as canal diameter, annular defect size, migrated disc, and foraminoplasty. Third, this study compared the clinical and radiological parameters of patients with rLDH at different times, and one case-control study is needed for further study, especially in terms of standardized sampling and data classification.
CONCLUSION: This study demonstrated that the recurrence rate of LDH at 5-year follow-up was 6.27% and there was a significant statistical relationship between FO, DHI, and Modic changes and early rLDH. Surgeons should take FO angles, DHI, and Modic change into consideration before surgery to achieve a satisfactory postoperative outcome and a relatively lower early recurrence rate. More patients and further investigation should be taken to assess the risk factors for early rLDH.
PMID:36288589
