Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors

Abstract

To investigate the preoperative radiological risk factors for recurrent lumbar disc herniation (rLDH) within 1 year after percutaneous endoscopic transforaminal discectomy (PETD). Patients and Methods: A retrospective case-control study was conducted. Between January 2013 and November 2019, a total of 1210 patients with single-level L4/5 LDH who underwent PETD were enrolled in the present study. In total, 62 rLDH patients were diagnosed and collected based on the clinical and radiological manifestations, and 224 non-rLDH controls were selected from the remaining 1148 patients. Preoperative radiological parameters were collected and measured. An age threshold to distinguish patients into subgroups was established using the Youden index. The relationships between the risk factors and rLDH were evaluated by univariate and multivariate analyses in two subgroups. Predictive models were established based on logistic analysis. The area under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to assess the predictive models. Results: In the present study, logistic analysis identified six significant predictors associated with rLDH in the young group: superior endplate concave angle (ECA), sacral slope, Modic changes, sagittal range of motion (sROM), extension intervertebral angle (IVA), and lumbar lordosis. Four significant predictors were identified in the elderly group: disc height index (DHI), retrolisthesis (posterior spondylolisthesis), sROM, and extension IVA. Validation of both models demonstrated excellent model discrimination (AUC= 0.940 and 0.946, respectively). DCA also showed excellent clinical utility and benefits. Conclusion:The nomograms that we constructed could accurately predict individual patient recurrence risk. Individualized measures should be taken for patients of different ages with the above risk factors, and tailored postoperative surveillance of patients who underwent PETD can be planned.

Identification of preoperative radiological risk factors for reoperation following percutaneous endoscopic lumbar decompression to treat degenerative lumbar spinal stenosis

“…However, as is discussed above, this influence may not be as significant in geriatric DLSS patients. This conclusion is consistent with other previous findings (20,44). Notably, due to the mechanical defect, patients with Modic changes, especially type 1, have a trend of deterioration in postoperative back pain, in which endoscopic procedures may be less effective (45).…”

“…Therefore, in this study we focused on the radiological characteristics, which are relatively objective indicators, and the influence of demographic characteristics on reoperation was decreased by matching. However, previous studies have proposed that risk factors might differ among subgroups (20).…”

“…Similarly, the level of Modic changes is not significantly associated with reoperation in this study. The presence of Modic changes has been considered to indicate local instability and therefore a risk factor for recurrent disc herniation postoperatively (20,43). However, as is discussed above, this influence may not be as significant in geriatric DLSS patients.…”

Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis

“…Previous studies have reported a variety of complications, such as recurrence of LDH (rLDH), incomplete decompression, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, intraoperative seizure, posterior neck pain, surgical site infection, and instrument breakage, in the treatment of LDH using PELD [ 1 , 2 , 12 – 14 ]. In addition, these complications are associated with multiple factors, including rLDH-related risk factors, such as obesity, old age, Modic changes, low grade of surgical-level disc degeneration, high disc height index (DHI), large sagittal range of motion, and severe grade of adjacent-level disc degeneration [ 15 – 18 ].…”

Development, validation, and visualization of a web-based nomogram to predict the effect of tubular microdiscectomy for lumbar disc herniation

“…Treatment improvement rate score ( 18 , 19 ) for the lumbar spine JOA score at 1 year after TMD: The lumbar spine JOA score method at 1 year after the operation was the same as that before the operation, and the treatment improvement rate was =[(post-treatment score—pre-treatment score) ÷ (full score 29—pre-treatment score)] × 100%. The improvement rate reflects the improvement of the lumbar spine function of the patient before and after treatment to evaluate the clinical efficacy: a cure rate of 100% was considered as cure, an improvement rate of more than 60% was considered as markedly effective, 25%–60% was considered as effective, and less than 25% was considered invalid.…”