Facet Angle and Disc Base Width: Hidden Risk Factors for Recurrence in Midline Lumbar Disc Herniation Surgery?

Abstract

Midline lumbar disc herniation is a common cause of low back pain and neurological symptoms often necessitating surgical intervention. However, recurrence after discectomy remains a significant concern. This study investigates whether facet joint angle and disc base width are predictive of recurrence and complications in patients undergoing lumbar discectomy. A retrospective review was conducted on 125 patients who underwent single-level discectomy for midline lumbar disc herniation. Patients with spondylolisthesis, prior lumbar surgery, or multilevel herniations were excluded. Preoperative MRI and CT scans were analyzed to measure disc base width and facet joint angle. Receiver operating characteristic analysis and multivariate logistic regression were performed to determine predictive values and independent risk factors for recurrence and complications. Mean follow-up was 60.1 ± 31.1 months. Recurrence occurred in 26 patients (20.8%) and complications in 10 patients (8%), with cerebrospinal fluid fistula being the most common. Reoperation was required in 27 patients (21.6%). Patients with complications had significantly greater facet angles (P = 0.001). A facet joint angle ≥53° was identified as an independent predictor of complications (odds ratio [OR] = 7.81; P = 0.013). A disc midpoint-to-midline distance <1 mm predicted both recurrence (OR = 2.99; P = 0.047) and complications. Chronic disease presence was also independently associated with recurrence (OR = 2.80; P = 0.037). Facet joint angle ≥53° and a disc midpoint distance <1 mm are significant predictors of recurrence and complications in midline lumbar disc herniation surgery. Preoperative evaluation of these factors may improve surgical planning and postoperative outcomes.