Risk Factors for Recurrent Herniation After Percutaneous Endoscopic Lumbar Discectomy.

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) has been widely used for treating lumbar disc herniation. Recurrence after PELD has been reported, but few studies have focused on the risk factors responsible for recurrence after PELD.

METHODS: This retrospective study enrolled 116 patients with recurrent herniation after successful PELD from March 2005 to March 2016. Kaplan-Meier method and Cox regression analysis were employed to identify significant risk factors predicting recurrence after PELD.

RESULTS: Univariate analysis showed that older age (≥50 years old), obesity (body mass index ≥25), no smoking history, decreased reflexes, learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), Modic change, migrated herniation, and central herniation are potential risk factors for recurrence after PELD. Multivariate analysis suggested that older age (≥50 years old), obesity (body mass index ≥25), learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), and central location of herniation are independent significant risk factors for recurrence after PELD.

CONCLUSIONS: Obesity (body mass index ≥25) was the most robust risk factor responsible for recurrence after PELD. Older age (≥50 years old), learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), and central location of herniation were also closely associated with recurrent herniation after successful PELD.