Earlier or heavier spinal loading tied to recurrent lumbar disc herniation after PELD

Fei Wang et al found in a study that-an older age, the male sex, a higher BMI, heavy work, grade II facet joint degeneration, and early ambulation are independent significant risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD).The study has been published in Journal of Orthopaedic Surgery and Research.

Percutaneous endoscopic lumbar discectomy (PELD), as a minimally invasive technique, has been widely used in the treatment of LDH. PELD yields clinical outcomes similar to those of microdiscectomy/ open discectomy. Meanwhile, PELD has the potential advantages of less blood loss, faster recovery of physical function, a shorter hospital stay, quicker pain relief and fewer complications. With the popularity of the PELD procedure, an increasing number of surgical complications have been reported, such as postoperative dysesthesia, nerve root injury, dural tears and recurrence

Recurrent lumbar disc herniation (rLDH) after PELD is one of the most concerning complications for spine surgeons and is the most important factor affecting the surgical outcome.

A total of 942 consecutive patients who underwent single-level PELD were included in the study. Patients were divided into the recurrence group and the nonrecurrence group. Patient characteristics, radiographic parameters and surgical variables were compared between the two groups. Univariate analysis and multiple logistic regression analysis were adopted to determine the risk factors for recurrence after PELD.

The results of the study were:

• The prevalence of rLDH was 6.05%.

• Age, sex, tobacco use, duration of low back pain, body mass index (BMI), occupational lifting, herniated disc type, facet joint degeneration, operation time and time to ambulation were significantly different between the two groups.

• Univariate analysis showed that age (P<0.001), sex (P=0.019), BMI (P=0.001), current smoking (P<0.001), sex (P=0.019), BMI (P=0.001), current smoking (P<0.001), occupational lifting (P<0.001), facet joint degeneration (P=0.001), operation time (P=0.002), and time to ambulation (P<0.001) could be significantly associated with the incidence of rLDH after PELD.

• Multivariate analysis suggested that an older age (P<0.001), the male sex (P=0.017), a high BMI (P<0.001), heavy work (P=0.003), grade II facet joint degeneration (P<0.001) and early ambulation (P< 0.001) were significantly related to rLDH after PELD.

The authors believe that external factors or incorrect postoperative rehabilitation exercise may play a key role in postoperative recurrence. The authors suggest that patients control their weight, avoid heavy work, ambulate at an appropriate time, and perform strengthening rehabilitation exercises to reduce the incidence of rLDH.

Further reading:

Earlier or heavier spinal loading is more likely to lead to recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy.

Fei Wang, Kai Chen et al

Journal of Orthopaedic Surgery and Research (2022) 17:356

https://doi.org/10.1186/s13018-022-03242-x