The factors influencing the curative effect of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation based on MRI indexes and clinical features
- VernacularTitle:基于磁共振成像参数和临床特征分析腰椎间盘突出症经皮椎间孔镜椎间盘切除术疗效的影响因素
- Author:
Hongmei ZHAO
1
;
Lu YU
Author Information
- Keywords: lumbar disc herniation(LDH); percutaneous transforaminal endoscopic discectomy(PTED); magnetic resonance imaging(MRI); clinical features; curative effect; influencing factor
- From: China Journal of Endoscopy 2024;30(9):78-84
- CountryChina
- Language:Chinese
- Abstract: Objective Based on magnetic resonance imaging(MRI)indexes and clinical characteristics to analyze the factors affecting the curative effect of percutaneous transforaminal endoscopic discectomy(PTED)in patients with lumbar disc herniation(LDH).Methods 302 patients with LDH from December 2019 to May 2022 were included in the study,all of whom received PTED with 1-year follow-up data.Among of them,272 cases had excellent curative effect and were included in the good prognosis group,while 30 cases had reasonable curative effect and were included in the poor prognosis group.General data,MRI indexes and clinical features of the subjects were collected retrospectively.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of curative effect in patients with LDH after PTED.Results In 302 cases of LDH,the excellent in 205 cases,good in 67 cases,fair in 30 cases and poor in 0 case,the prognosis rate was 9.93％.Compared with the good prognosis group,the poor prognosis group had higher proportions of smoking,disc degeneration,longer operation time,higher absolute difference in cross-sectional area(CSA)of psoas major and multifidi,and lower intervertebral foramen area,with statistical significance(P＜0.05).There was no significant difference in age,body mass index(BMI),gender,alcohol consumption,diabetes mellitus,hypertension,hyperlipidemia,annulus fibrosus rupture,lesion segment,Lee zone,Modic change,intraoperative blood loss,incision length,surgical approach,and arthroscopic model between the two groups(P＞0.05).The multivariate Logistic analysis showed that:Smoking(OR=4.179,95％CI:1.035～16.865),gradeⅣ disc degeneration(OR=6.863,95％CI:2.049～22.983),the difference of CSA of psoas major＞1.63 cm2(OR=19.084,95％CI:3.566～102.130)and the difference of CSA of multifidi＞1.02 cm2(OR=482.525,95％CI:19.538～12 137.347)were risk factors for poor prognosis of patients with LDH after PTED,the differences were statistically significant(P＜0.05).The intervertebral foramen area＞118.31 mm2(OR=0.750,95％CI:0.721～0.862)was protective factor for poor prognosis of patients with LDH after PTED,and the difference was statistically significant(P＜0.05).Conclusion Smoking,grade Ⅳ intervertebral disc degeneration,greater than 1.63 cm2 absolute difference in psoas major CSA,and greater than 1.02 cm2 absolute difference in multifidi CSA are risk factors for poor prognosis of PTED in LDH patients.Intervertebral foramen area＞118.31 mm2 is a protective factor for poor prognosis of PTED in LDH patients.Clinically,high-risk patients with poor prognosis can be screened and corresponding intervention strategies can be taken.
