Radiologic and Patient-derived Predictors for Recurrent Lumbar Disc Herniation After Minimally Invasive Tubular Discectomy: A Single-center Analysis of 404 Patients.

Abstract

Lumbar discectomy is an effective surgical treatment for radiculopathy due to lumbar disc herniation (LDH); however, recurrent LDH (rLDH) after discectomy may result in continued radiculopathy, necessitating reoperation. This is associated with worse patient outcomes and further revision surgeries. A retrospective, single-center review was performed on a prospectively collected database of patients who underwent minimally invasive discectomy for treatment of LDH from 2013-2020, totaling 404 patients. Both patient-derived (age, sex, body mass index, smoking status, and diabetes status) and radiologic (disc height index, Modic endplate changes, and herniation subtype) risk factors were assessed. LDHs were subclassified as either protrusion, subligamentous extrusion, transligamentous extrusion, or sequestration. Patients were grouped based on incidence of recurrence and statistical analysis was performed on the previously noted variables. The recurrence of rLDH after minimally invasive surgery was calculated to be 12.13%. The recurrence group had a higher prevalence of any type of Modic change and thus a decreased prevalence of no Modic changes. There was an increased prevalence of subligamentous and decreased prevalence of transligamentous disc herniations in the recurrence group. Tubular lumbar discectomy has similar rates of recurrent lumbar disc herniations when compared to traditional open microdiscectomy surgery. Our data suggest that Modic endplate changes are associated with increased risk of recurrent lumbar disc herniation. The rate of comorbid diabetes mellitus was non-significantly higher in patients who experienced a reherniation. Although not statistically significant, the recurrence group showed an increased prevalence of subligamentous herniations, suggesting that this herniation subtype may be associated with recurrence.