Factors and re-treatment for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy

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Background Percutaneous endoscopic lumbar discectomy (PELD) has become the most common treatment for lumbar disc herniation (LDH). However, the risk of recurrence after PELD is inevitable. Therefore, clarifying the factors for recurrent LDH is necessary to improve the success rate and reduce the postoperative recurrence rate. The study aimed to investigate the postoperative recurrence rate, factors and re-treatment of recurrent LDH after PELD. Methods A total of 685 LDH patients who underwent PELD in our hospital from January 2015 to December 2017 were enrolled in this retrospective study. Postoperative recurrence rate was calculated. Outcomes for re-treatment of recurrent LDH were assessed by comparing VAS and JOA scores before the first surgery, after recurrence and at the final follow-up in patients with recurrent LDH. The factors for recurrent LDH were analyzed by univariate and multivariate analysis. Results Recurrent LDH was observed in 23 (3.35%) patients, including 21 cases of ipsilateral recurrent herniation, and 2 cases of contralateral recurrent herniation. Mean recurrence time was 5.4 ± 2.6 months (range, 0.5–11 months). VAS score was decreased, while JOA score was increased at the final follow-up compared with the scores measured before the first surgery and after recurrence. Univariate analysis revealed that body mass index (BMI), the types of disc herniation and postoperative activity levels were correlated with postoperative recurrence, while no correlation was found between sex, age, smoking history, the levels and position of herniated disc and recurrent LDH. Multivariate analysis showed that high BMI, the types of disc herniation (i.e. extrusion, sequestration) and high-intensity postoperative activity levels were risk factors for recurrent LDH. Conclusions High BMI, the extrusion and sequestration types of disc herniation, and high-intensity postoperative activity levels may significantly increase the incidence of recurrent LDH. All patients with recurrent LDH had satisfactory results after re-treatment.