The relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic spinal surgery in patients with lumbar disc herniation of different ages

English Keywords:Lumbar disc herniation  Unilateral biportal endoscopic spinal surgery  Spinal-pelvic sagittal sequence  Recurrence

English Abstract:

  【Abstract】 Objectives: To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE) spinal surgery in patients with lumbar disc herniation of different ages. Methods: 200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects. They were divided into two groups according to ages: 94 patients under 45 years old were included in the young and middle-aged group, and 106 patients at 45 years old and over were included in the middle-aged and elderly group. The spinal-pelvic sagittal sequence parameters, including thoracic kyphosis(TK), pelvic incidence(PI), pelvic tilt(PT), lumbar lordosis(LL), sacral slope(SS), were measured on preoperative lateral X-ray films of the entire spine. The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis. After discharge, the patients were followed up for 2 years and divided into a recurrent group(n=33) and a non-recurrent group(n=167) based on the recurrence condition during the follow-up period. Multivariate logistic regression analysis was conducted to identify the influencing factors of recurrence. The receiver operating characteristic curve(ROC) was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence; And the area under the ROC curve(AUC) was determined, and the 95% confidence interval(CI) was calculated. Results: The LL, PI, PT, and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960, 2.163, 2.245, 2.296, P<0.05). Pearson analysis showed that LL, PI, PT, and SS were negatively correlated with age(r=-0.67, -0.72, -0.65, -0.63, P<0.001). The proportion of patients aged ≥45 years and with a annulus fibrosus rupture >5mm in the recurrent group was higher than that in the non-recurrent group, while LL, PI, and SS were lower than those in the non-recurrent group(P<0.05). Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694, 95%CI: 2.231-2.945, P<0.05), while elevated LL(OR=0.623, 95%CI: 0.435-0.895, P<0.05) and elevated SS were protective factors for recurrence(OR=0.687, 95%CI: 0.412-0.738, P<0.05). The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95%CI: 0.670-0.856) and 0.754(95%CI: 0.669-0.872), respectively. The AUC for predicting patient recurrence using both methods was 0.852(95%CI: 0.769-0.903). Conclusions: The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk. Age ≥45 years is an independent risk factor for postoperative recurrence, while higher LL and SS are protective factors. Preoperative evaluation of spinal-pelvic sagittal sequence, especially LL and SS, can help identify high-risk populations for UBE postoperative recurrence and provide important references for individualized surgical strategies.