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Risk factors for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a meta-analysis of 58 cohort studies

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Abstract

Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m2) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.

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Funding

This work was supported by the Health and Family Planning Commission Program of Hunan Province (no. 202204074707), and the Health and Family Planning Commission Program of Wuhan City (no. WX18C29).

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  1. Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China

    Mingjiang Luo, Zhongze Wang, Jiang Chen, Siliang Tang, Jingshan Huang & Zhihong Xiao

  2. Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China

    Zhongze Wang, Beijun Zhou & Gaigai Yang

  3. Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi, 830054, China

    Yuxin Shi

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Contributions

ML and ZW conceived the idea for the review and with all other authors designed the protocol. FS constructed the search. ML, ZW, BZ GY, and YS selected the studies and extracted the relevant data. ML and ZW wrote the original draft and ZX and ZX critically revised and edited successive drafts of the paper. All authors gave final approval of the version to be submitted.

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Luo, M., Wang, Z., Zhou, B. et al. Risk factors for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a meta-analysis of 58 cohort studies. Neurosurg Rev 46, 159 (2023). https://doi.org/10.1007/s10143-023-02041-0

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