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Background <p>Recurrent lumbar disc herniation (RLDH) after endoscopic lumbar discectomy (ELD) remains challenging, with recurrence rates of 2.8–15%. Identifying risk factors and predictive tools is crucial for improving outcomes. This single-center retrospective study investigated clinical, imaging, and histological risk factors for RLDH and developed a Comprehensive Recurrent Score (CR Score) for prediction.</p> Methods <p>80 patients (40 RLDH, 40 non-recurrent) were analyzed. Data included demographics, clinical characteristics, imaging (Modic changes [MCs], disc height index [DHI], operation time), and disc histology (IL-1β, TNF-α, IBA-1). Logistic regression was used to identify risk factors, and a CR Score was developed and validated internally and externally.</p> Results <p>Key risk factors for RLDH included BMI ≥ 28&#xa0;kg/m<sup>2</sup> (<i>p</i> = 0.03), worker occupation (<i>p</i> = 0.002), MCs (0, no Modic change on MRI) (<i>p</i> = 0.003), oral medication use (<i>p</i> = 0.04), and operation time of 60–90&#xa0;min (<i>p</i> = 0.002). Protective factors included MCs (2) (<i>p</i> = 0.03), clerk occupation (<i>p</i> = 0.0008), and operation time ≥ 90&#xa0;min (<i>p</i> = 0.04). Among these, MCs (0) was the only independent risk factor for RLDH (<i>p</i> = 0.02). The CR Score, incorporating these factors, effectively stratified patients into low (&lt; 3 points), medium (3–6 points), and high (≥ 6 points) risk groups. Internal and external validation showed predictive accuracy, with medium-to-high risk patients accounting for over 60% of recurrence cases.</p> Conclusion <p>The CR Score is a practical tool for risk stratification, aiding individualized postoperative management and prevention. Further multicenter validation is needed.</p>

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A retrospective study on risk factors and the development of a comprehensive recurrent score (CR Score) for recurrence after endoscopic lumbar discectomy

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Yongxiong Huang,
  • Zhenxiao Ren,
  • Wenlin Ye,
  • Zhengran Yu,
  • Tao Yu,
  • Lutong Wang,
  • Zongyuan Deng,
  • Yongyu Ye,
  • Chong Chen,
  • Honglin Gu,
  • Dong Yin,
  • Yunbing Chang,
  • Dan Xiao,
  • Wenjie Hu,
  • Xing Cheng

摘要

Background

Recurrent lumbar disc herniation (RLDH) after endoscopic lumbar discectomy (ELD) remains challenging, with recurrence rates of 2.8–15%. Identifying risk factors and predictive tools is crucial for improving outcomes. This single-center retrospective study investigated clinical, imaging, and histological risk factors for RLDH and developed a Comprehensive Recurrent Score (CR Score) for prediction.

Methods

80 patients (40 RLDH, 40 non-recurrent) were analyzed. Data included demographics, clinical characteristics, imaging (Modic changes [MCs], disc height index [DHI], operation time), and disc histology (IL-1β, TNF-α, IBA-1). Logistic regression was used to identify risk factors, and a CR Score was developed and validated internally and externally.

Results

Key risk factors for RLDH included BMI ≥ 28 kg/m2 (p = 0.03), worker occupation (p = 0.002), MCs (0, no Modic change on MRI) (p = 0.003), oral medication use (p = 0.04), and operation time of 60–90 min (p = 0.002). Protective factors included MCs (2) (p = 0.03), clerk occupation (p = 0.0008), and operation time ≥ 90 min (p = 0.04). Among these, MCs (0) was the only independent risk factor for RLDH (p = 0.02). The CR Score, incorporating these factors, effectively stratified patients into low (< 3 points), medium (3–6 points), and high (≥ 6 points) risk groups. Internal and external validation showed predictive accuracy, with medium-to-high risk patients accounting for over 60% of recurrence cases.

Conclusion

The CR Score is a practical tool for risk stratification, aiding individualized postoperative management and prevention. Further multicenter validation is needed.