A study on the influencing factors and model construction of recurrence in patients with lumbar disc herniation treated with Percutaneous transforaminal endoscopic surgery

Liu Jianfeng; Xu Zhanwu; Liu Wei; Wang Dexin; Jiao Peilei; Zhang Wenjin

doi:10.3969/j.issn.1674-3245.2024.06.032

Abstract：Objective To exploring the influencing factors of recurrence in patients with lumbar disc herniation(LDH)treated with Percutaneous transforaminal endoscopic surgery(PTED).Methods The clinical data of 738 patients with LDH who received PTED treatment in the 962 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army(February 2020 to February 23)were retrospectively analyzed.All patients were followed up for one year,and the patients who recurred after one year of follow-up were included in the recurrence group(72 cases,36 cases in the modeling group and 36 cases in the validation group),and the remaining patients were included in the non recurrence group(666 cases,333 cases in the modeling group and 333 cases in the validation group).The clinical data of four compared were compared and the risk factors for recurrence in patients with LDH after percutaneous foraminoscopic surgery was analyzed by multivariate logistic regression analysis.The predictive model was constructed,and ROC curve was plotted to analyze its value in predicting relapse in LDH patients after PTED.Results In the modeling group,the proportion of patients aged≥65 years in the recurrent group was higher than that in the non recurrent group(30.56％vs.15.02％),the proportion of patients with a body mass index≥24 kg/m2 in the recurrent group was higher than that in the non recurrent group(47.22％vs.17.72％),and the proportion of patients with intervertebral disc degeneration grades Ⅳ～Ⅴ in the recurrent group was higher than that in the non recurrent group(58.33％vs.40.84％).Compared with the non recurrent group,the degree of sagittal rotation and score of postoperative activity in the recurrent group were higher,the course of the disease was longer(χ2=5.686,17.293,4.067,t=3.659,2.883,2.434,P<0.05).In the validation group,the proportion of patients aged≥65 years in the recurrence group was higher than that in the non recurrence group(38.89％vs.16.22％),the proportion of patients with a body mass index≥24 kg/m2 in the recurrence group was higher than that in the non recurrence group(44.44％vs.21.32％),and the proportion of patients with intervertebral disc degeneration grade Ⅳ～Ⅴ in the recurrence group was higher than that in the non recurrence group(63.89％vs.43.84％);Compared with the non recurrent group,the sagittal plane rotation degree and postoperative activity score were higher,and the recurrent group had a longer disease course(χ2=11.110,9.640,5.259,t=6.284,1.277,2.459,P<0.05).Age≥65 years,body mass index≥24 kg/m2,and high score of postoperative activity of patients with LDH after PTED of risk factors for recurrence(OR=2.155,2.625,1.929,P<0.05).Regression equation model:logit(P)=-11.874+age×0.768+body mass index×0.965+the score of postoperative activity×0.657.The ROC curve shows that when logit(P)>12.18,χ2 and the area under curve(AUC)value were 13.468,0.879,respectively,and the 95％CI was 0.841～0.911,the diagnostic sensitivity and specificity were 86.11％and 76.28％,respectively.Conclusion The independent risk factors for recurrence in LDH patients undergoing PTED surgery included age≥65 years,high score of postoperative activity and body mass index≥24 kg/m2.The model constructed based on this has high predictive value and can be used clinically to provide corresponding nursing interventions for high-risk patients to reduce postoperative recurrence.