Influencing factors of postoperative recurrence of single-segment lumbar disc protrusion with lumbar spinal stenosis treated by percutaneous endoscopic lumbar discectomy

English Keywords:Lumbar disc herniation  Lumbar spinal stenosis  Percutaneous endoscopic lumbar discectomy  Changes in the structure of the spinal canal

English Abstract:

  【Abstract】 Objectives: To investigate the correlation between postoperative recurrence and spinal canal changes in patients with lumbar spinal stenosis and lumbar disc herniation(LDH) treated by percutaneous endoscope lumbar discectomy(PELD). Methods: A retrospective analysis of 155 patients with LDH and lumbar spinal stenosis who underwent PELD treatment in our hospital from January 2016 to June 2018, including 93 males and 62 females, with an average age of 51.9±9.3 years. After the patients were discharged from the hospital, they were followed up for a period of 2 years. The patients were divided into recurrence group and non-recurrence group according to the recurrence situation during the follow-up period. The clinical data of the two groups of patients were compared, including age, course of disease, gender composition, body mass index (BMI), smoking history, underlying disease, stenosis grade, lesion location and classification, waist visual analog score(VAS), and lower limb JOA and ODI scores. MRI examinations were performed on the patients 5 to 7 days preoperatively and 7 days after the operation, from which imaging examination related information (including the cross-sectional area of the spinal canal before and after the operation, the cross-sectional area of the dural sac, the sagittal diameter of the intervertebral foramina and the width of the lateral recess and their differences) was collected. Logistic regression was used to analyze the related factors of postoperative recurrence, andthe type of spinal stenosis was used as the selected variable to analyze the related factors of different types of spinal stenosis(P<0.1). Results: A total of 155 patients completed the follow-up, and 19 patients relapsed during the follow-up period. The difference of lumbar spine stenosis grading was statistically significant (P=0.002) between the non-recurrence group (75 cases in grade 1, 47 cases in grade 2, 14 cases in grade 3) and the recurrence group (5 cases in grade 1, 6 cases in grade 2, and 8 cases in grade 3). There was no statistically significant differences between the two groups of patients in age, course of disease, gender composition, BMI, smoking history, underlying disease, lesion location, preoperative VAS, lower limb JOA and ODI scores. The ICCA (difference value) (0.36±0.18cm2 vs 0.19±0.13cm2, P<0.001), DSCA (difference value) (0.23±0.09cm2 vs 0.09±0.04cm2, P<0.001), sagittal diameter of intervertebral foramina (difference value) (1.22±0.48mm vs 0.93±0.53mm, P=0.016) and lateral crypt width (difference) (1.37±0.44mm vs 1.14±0.67mm, P<0.001) in the non-recurrence group were higher than those of the recurrence group, and the differences were statistically significant. The grade of stenosis, ICCA (difference), DSCA (difference) and lateral recess width (difference) were negatively correlated with postoperative recurrence(P<0.05). DSCA (difference) was negatively correlated with recurrence of central intervertebral canal stenosis (OR<0.001, P=0.001). ICCA (difference) (OR=0.001, P=0.006) and sagittal foraminal diameter (difference) (OR=0.001, P=0.038) were negatively correlated with the recurrence of foraminal stenosis. The width of the lateral crypt (difference) (OR=0.004, P=0.009) was negatively correlated with the recurrence of lateral crypt stenosis. Conclusions: The recurrence of LDH with lumbar spinal stenosis after PELD is related to the changes of ICCA, DSCA, intervertebral foramina sagittal diameter and cross-sectional area of the dural sac before and after the operation, which is of positive significance in guiding range of decompression and the judgment of the clinical operation.