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Background <p>Recurrent lumbar disc herniation (rLDH) remains a major cause of treatment failure after percutaneous endoscopic lumbar discectomy (PELD). The roles of spinopelvic parameters and facet joint degeneration in postoperative recurrence have not been fully clarified.</p> Objective <p>To investigate the associations between spinopelvic parameters, facet joint degeneration, and recurrent lumbar disc herniation after PELD.</p> Methods <p>A total of 106 patients who underwent single-level PELD were retrospectively analyzed, including 53 patients with recurrence (rLDH group) and 53 without recurrence (non-rLDH group). Propensity score matching was performed to balance baseline characteristics. Clinical and radiological parameters, including pelvic incidence (PI), lumbar lordosis (LL), PI–LL mismatch, disc height (DH), range of motion (ROM), facet joint degeneration, Pfirrmann grade, and Modic changes, were evaluated. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.</p> Results <p>After matching, no significant differences were observed in age, sex, BMI, or surgical level between the two groups (all <i>P</i> &gt; 0.05). The rLDH group exhibited significantly greater PI–LL mismatch, DH, ROM, facet degeneration, Pfirrmann grade, and a higher prevalence of Modic changes (all <i>P</i> &lt; 0.05). Multivariate analysis identified DH (OR = 1.50, 95% CI: 1.14–1.97), facet degeneration (OR = 6.00, 95% CI: 1.74–20.70), Modic changes (OR = 7.35, 95% CI: 1.55–34.86), PI–LL mismatch (OR = 1.08, 95% CI: 1.01–1.14) as independent predictors of recurrence. ROC analysis showed that DH (AUC = 0.785) and ROM (AUC = 0.749) had the highest predictive value.</p> Conclusions <p>PI–LL mismatch, facet joint degeneration, disc height, and Modic changes are independent risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy. PI–LL mismatch greater than 10° and facet joint degeneration (Weishaupt grade ≥ 2) are significantly associated with an increased risk of recurrence.</p>

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Risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy: the role of spinopelvic parameters and facet joint degeneration

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Xiangdong Gong,
  • Shiyong Wang,
  • Rubin Yao,
  • Lirong Ren,
  • Shaobo Li,
  • Baojia Yang,
  • Jianrong He,
  • Zhongjie Li,
  • Feifei Liu,
  • Yushan Ruan,
  • Kaishun Yang,
  • Ming zhang

摘要

Background

Recurrent lumbar disc herniation (rLDH) remains a major cause of treatment failure after percutaneous endoscopic lumbar discectomy (PELD). The roles of spinopelvic parameters and facet joint degeneration in postoperative recurrence have not been fully clarified.

Objective

To investigate the associations between spinopelvic parameters, facet joint degeneration, and recurrent lumbar disc herniation after PELD.

Methods

A total of 106 patients who underwent single-level PELD were retrospectively analyzed, including 53 patients with recurrence (rLDH group) and 53 without recurrence (non-rLDH group). Propensity score matching was performed to balance baseline characteristics. Clinical and radiological parameters, including pelvic incidence (PI), lumbar lordosis (LL), PI–LL mismatch, disc height (DH), range of motion (ROM), facet joint degeneration, Pfirrmann grade, and Modic changes, were evaluated. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.

Results

After matching, no significant differences were observed in age, sex, BMI, or surgical level between the two groups (all P > 0.05). The rLDH group exhibited significantly greater PI–LL mismatch, DH, ROM, facet degeneration, Pfirrmann grade, and a higher prevalence of Modic changes (all P < 0.05). Multivariate analysis identified DH (OR = 1.50, 95% CI: 1.14–1.97), facet degeneration (OR = 6.00, 95% CI: 1.74–20.70), Modic changes (OR = 7.35, 95% CI: 1.55–34.86), PI–LL mismatch (OR = 1.08, 95% CI: 1.01–1.14) as independent predictors of recurrence. ROC analysis showed that DH (AUC = 0.785) and ROM (AUC = 0.749) had the highest predictive value.

Conclusions

PI–LL mismatch, facet joint degeneration, disc height, and Modic changes are independent risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy. PI–LL mismatch greater than 10° and facet joint degeneration (Weishaupt grade ≥ 2) are significantly associated with an increased risk of recurrence.