Early recurrence of herniated nucleus pulposus after percutaneous endoscopic lumbar discectomy: A retrospective cohort study of 1,278 patients

Background: Some have determined that percutaneous endoscopic lumbar discectomy (PELD) effectively treats lumbar herniated nucleus pulposus, but there is concern regarding a high 6-month postoperative recurrence rate. Risk factors reportedly associated with the heightened risk of disc recurrences include high body mass index (BMI), male sex, and operative approach. Further, it may be difficult to differentiate recurrent discs from other pathologies/factors that may mimic disc recurrence. Methods: In this retrospective cohort study, we reviewed demographic, clinical, radiological, and operative data for 1,278 patients undergoing PELD from 2011 to 2022. Recurrent discs were defined by recurrent radicular symptoms appearing at least 4 weeks postoperatively and were confirmed by magnetic resonance imaging scans to be at the same level and on the same side. Using Cox proportional hazards models, we predicted recurrence rates. We also utilized Kaplan–Meier survival analysis to evaluate recurrence-free survival stratified by BMI, surgical approach, and sex. Results: The 6-month recurrence rate was 1.02/100 person-months. In multivariable analysis, male sex, BMI ≥25 kg/m 2 , and the use of the extraforaminal approach were independent predictors of disc recurrence. Kaplan– Meier curves demonstrated significantly lower recurrence-free survival among male patients, overweight/obese individuals, and those treated through the extraforaminal approach. Conclusion: Male sex, high BMI, and extraforaminal approaches proved to be significant independent risk factors correlating with early disc recurrence rate following PELD.