Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy

Abstract

Introduction

Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15–25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain.

Methods

A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain.

Results

Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain.

Discussion

This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.

Keywords:

• spine
• endoscopy
• radiology
• minimally invasive surgical procedure
• postoperative low back pain

Date Availability

The data are available from the corresponding author on reasonable request.

Ethic Declaration

The Ethics Committee of Shanghai Changzheng Hospital does not require us to obtain explicit written consent from patients. Because all operative procedure had undergo rigorous ethical review for keeping the safety of medical care and individual privacy. All patients’ data were reserved confidentially under the inspection of the ethical committee even if without written consent. And all surgical procedures have no adverse effect on the patient’s prognosis. We will always comply with relevant laws, regulations, and international ethical guidelines, particularly the “Helsinki Declaration”.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare for this work.

Additional information

Funding

This work is sponsored by Science Foundation of Shanghai “The application of PIS aspiration system in the early treatment of intervertebral disc herniation and foraminoscopy” (21Y11911300) and also sponsored by NSFC “the modulation of integrin alpha6 in hypoxia effect on degeneration of nucleus pulposus cells” (82072485).