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

Wang, Fei; Chen, Kai; Lin, Qiu-shui; Ma, Yuegang; Huang, Hao; Wang, Chuanfeng; Zhou, Ping

doi:10.1186/s13018-022-03242-x

Cited by 14 publications

(15 citation statements)

References 27 publications

(42 reference statements)

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“…al in 2022 18 found this correlation statistically signi cant (p = 0.017), the same has done by Wang et.al. in 2022 19 that found a signi cant correlation both with BMI and patient age (BMI p = 0.001, age p < 0.001) while Li et. al.…”

Section: Discussionmentioning

confidence: 95%

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Monticelli

Gelmi

Scerrati

et al. 2023

Preprint

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Study design This is a retrospective monocentric studyObjective The aim of this study is to analyze the incidence of recurrent or junctional lumbar foraminal herniated disc, in patients treated with trans pars microsurgical approach.Background Foraminal lumbar disc herniation represents a challenging pathology for the spinal surgeon. The appropriate surgical approach still represents a matter of debate. Several open and minimally-invasive techniques have been developed, in order to allow a proper tissue exposure and preserving the vertebral stability. The trans-pars approach has already been described as a possible alternative, allowing excellent exposure of the herniated fragment with minimum bone removal. While few studies have analyzed the very low rate of post-operative instability, no articles deal with the incidence of post-operative herniated disc recurrence or junctional disc herniation in patients treated with this technique.Methods We enrolled 160 patients operated at our institution.A univariate and multivariate analysis of possible factors influencing outcome (age, sex, level and BMI) was performed. Outcome variables were: recurrent or junctional herniated disc. Results At the end 135 patients were analyzed. Of the 135 patients, six presented recurrent herniated disc (4.4%) and other three developed a junctional herniation (2.2%). The occurrence of junctional herniated disc or recurrent herniated disc were not influenced by the analyzed variables, both at univariate and at multivariate analysesConclusion The trans pars approach presents a low rate of recurrence and junctional herniation. Age, sex, level and BMI do not influence the recurrence rate, both at same level and at junctional level.

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Section: Discussionmentioning

confidence: 95%

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Monticelli

Gelmi

Scerrati

et al. 2023

Preprint

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show abstract

“…Certain researchers propose that, considering the characteristics of fibrous soft tissue scarring and wound healing, patients should be confined to bed for at least 3 weeks. 26 Nevertheless, adhering to such requirements proves challenging for many patients. Our study found that the average time to ambulation was 4.59±1.05 days in the recurrence group and 5.25±1.18 days in the non-recurrence group, with a statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Nomogram Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Activity Factors

Tang,

Wang,

Wang

et al. 2024

RMHP

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Purpose To develop an individualized predictive model for postoperative recurrent lumbar disc herniation (PRLDH) in patients undergoing percutaneous endoscopic transforaminal discectomy (PETD) by considering postoperative activity factors. Patients and Methods Retrospectively collected data from 612 LDH patients who underwent PETD in our institution from January 2017 to June 2023. They were divided into a training group (429 cases) and a validation group (183 cases). Lasso regression (Model 1) and random forest (Model 2) were applied for variable selection in the training group. The two models were compared in terms of discrimination (the area under curve, AUC), calibration (calibration curve), and clinical utility (decision curve analysis, DCA). Akaike information criterion (AIC) was used for model comparison, and internal validation employed 1000 times Bootstrap + 10-fold cross-validation. Finally, a Nomogram was constructed to display the results and uploaded to the web version. Results Among 612 treated LDH patients, 66 (10.78%) developed PRLDH. Model 1, superior in AUC, calibration, DCA, and AIC over Model 2, was chosen as the predictive model. Logistic regression in the training group identified BMI, smoking, activity level score, time to first ambulation, diabetes, Modic change, and Pfirrmann grade as independent predictors of PRLDH. Model 1 exhibited a training group AUC of 0.813 (95% CI 0.753–0.872) and a validation group AUC of 0.868 (95% CI 0.773–0.962). At a Youden index of 0.50, sensitivity was 0.73, specificity was 0.77. Internal validation (1000 times Bootstrap + 10-fold cross-validation) for the training group showed accuracy of 0.889, kappa consistency of 0.112, and AUC of 0.757. The Hosmer-Lemeshow goodness-of-fit tests indicated good discriminative ability for Model 1 in both the training ( χ 2 =2.895, P =0.941) and validation groups ( χ 2 =8.197, P =0.414). The DCA and Nomogram are accessible at https://sofarnomogram.shinyapps.io/PRLDHNom/ . Conclusion The Nomogram predictive model, developed based on postoperative activity factors in this study, demonstrates excellent predictive capability, facilitating risk assessment for the occurrence of PRLDH after PETD.

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“…20 Risk factors for postoperative disc herniation recurrence in FED include old age (> 50 years), obesity (body mass index > 25 kg/m 2 ), upper disc (L1/2, L2/3, and L3/4), 19 male sex, heavy work, facet joint degeneration, and early ambulation. 21,22 Qin et al 22 reported a significantly higher recurrence rate in early ambulation patients who were ambulated within 24 hours after FED, and the importance of time to first ambulation as a factor in postoperative recurrence.…”

Section: Recurrent Disc Herniationmentioning

confidence: 99%

“…The annular sealing method is used to prevent recurrence by coagulating and shrinking the area around annular fissure with a bipolar coagulator and sealing the annular defect. 17,25 Wang et al 21 found that the average time to ambulation was significantly shorter in recurrent cases (17 days in the recurrent group vs. 24 days in the normal group) and emphasized the importance of limiting postoperative upright activity. It is believed that external stress on the lumbar region and incorrect postoperative rehabilitation may influence recurrence, and weight control, avoidance of heavy work, and strengthening rehabilitation are recommended.…”

Section: Recurrent Disc Herniationmentioning

confidence: 99%

Perioperative Management for Full-Endoscopic Lumbar Discectomy: Consideration From the Perspective of Preventing Complication

Hara

Ohara

2023

Neurospine

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In recent years, full-endoscopic discectomy (FED) has expanded its range of indications with the development of devices and various techniques. The advantage of FED over conventional surgery is that it is a minimally invasive procedure. However, intraoperative and postoperative precautions must be taken to prevent complications. It is necessary to avoid complications that could compromise the outcome of the procedure. Effective perioperative management is necessary to avoid complications; however, there is no set view for perioperative management in FED. In this study, we perform a literature review to examine the effectiveness of perioperative management methods for FED. The key to ensuring the efficacy and minimal invasiveness of FED is prevention of complications. Based on the result and literature review, we believe that the most manageable postoperative management after FED is prevention of recurrent disc herniation and hematoma formation. A drain should be placed to prevent postoperative hematoma formation. It is advisable to evaluate the patient’s symptoms and monitor C-reactive protein and erythrocyte sedimentation rate levels during the first week after surgery. Postoperative antibiotics were administered for 1 day.

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

Cited by 14 publications

References 27 publications

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Recurrent or junctional lumbar foraminal herniated disc in patients operated withtrans pars microscopic approach

Development and Validation of a Nomogram Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Activity Factors

Perioperative Management for Full-Endoscopic Lumbar Discectomy: Consideration From the Perspective of Preventing Complication

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