Clinical observation of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation and analysis of influencing factors for recurrence.

Abstract

Objective: To investigate the clinical effects of percutaneous transforaminal endoscopic discectomy (PELD) in treating lumbar disc herniation (LDH) and analyze the related factors for postoperative recurrence.

Methods: A retrospective analysis was conducted on 168 patients with lumbar disc herniation who underwent percutaneous transforaminal endoscopy at the Second Hospital of Tangshan from January 2017 to January 2021. The patients were followed up for 1 year. The Oswestry disability index (ODI) and visual analog scale (VAS) for low back pain/radicular pain were recorded before the operation and at the final follow-up. The patients' overall responses were evaluated according to Stauffer-Coventry's response evaluation criteria. Univariate analysis and multivariate logistic regression were used to analyze the relationship between basic data indicators and postoperative recurrence.

Results: Compared with preoperative values, the postoperative VAS scores and ODI indices were significantly reduced at different time points (both P < 0.05). During the final follow-up, the efficacy was rated as excellent in 55 cases, good in 59 cases, fair in 35 cases, and poor in 19 cases, with an overall excellent and good rate of 67.86%. Among them, 12 patients had postoperative recurrence, with a recurrence rate of 7.14%. Univariate analysis indicated that age ≥ 49 years, BMI ≥ 24.62 kg/m², partition of disc herniation location, intraoperative annulus fibrosus damage, and incomplete removal of nucleus pulposus during surgery were independent risk factors for postoperative recurrence (all P < 0.05).

Conclusion: PELD surgery for LDH can achieve favorable clinical efficacy. However, intraoperative annulus fibrosus injury and incomplete removal of the nucleus pulposus during surgery may lead to secondary recurrence in patients.