Analysis of risk factors and construction of a prediction model for recurrence after percutaneous endoscopic lumbar discectomy

English Keywords:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Postoperative recurrence  Risk factors  Predictive model

English Abstract:

  【Abstract】 Objectives: To identify the independent risk factors for recurrence after percutaneous endoscopic lumbar discectomy(PELD) and to develop and validate a nomogram-based model for predicting postoperative recurrence risk to provide reference for clinical decision-making. Methods: A total of 312 patients with single-segment lumbar disc herniation(LDD) who underwent PELD in our hospital from January 2017 to December 2022 were retrospectively included and divided into a recurrence group and a non-recurrence group. Data including age, sex, body mass index(BMI)(<25kg/m2, ≥25kg/m2), disease duration(<1 year, 1-2 years, >2 years), postoperative activity level score(0-2, 3-4, 5-6), herniation type(protrusion, extrusion, sequestration) and location(central, paracentral, far lateral), Modic changes(yes, no), and Pfirrmann grade(2 years, sequestrated herniation, BMI≥25, Modic changes, Pfirrmann grade ≥Ⅲ, and a postoperative activity level score of 5-6 as independent risk factors for postoperative recurrence. The nomogram model showed an AUC of 0.803(95%CI: 0.738-0.869), a mean ten-fold cross-validation score of 0.8366, indicating a good calibration. Conclusions: BMI≥25, disease duration >2 years, postoperative activity level score 5-6, sequestered herniation, Modic changes, and Pfirrmann grade ≥Ⅲ are the independent risk factors for recurrence after PELD.