2023, Vol. 27 ›› Issue (13): 2087-2092

Establishment and validation of a prognostic model for the recurrence risk after percutaneous endoscopic lumbar discectomy

Li Xin1, Luo Mingran1, Li Gen1, Cheng Lin2, Pan Bin2, Yuan Feng2, 3   

Abstract: BACKGROUND: Recurrent lumbar disc herniation is an adverse event after percutaneous endoscopic lumbar discectomy. Accurately predicting the risk of recurrent lumbar disc herniation after surgery remains a major challenge for spine surgeons.
OBJECTIVE: To investigate the risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy, and to develop and validate an effective predictive model.
METHODS: Clinical data from 365 patients with lumbar disc herniation who underwent percutaneous endoscopic lumbar discectomy at the Affiliated Hospital of Xuzhou Medical University from January 1, 2017 to January 1, 2020 were retrospectively collected. Predictors significantly associated with postoperative lumbar disc herniation recurrence were screened according to least absolute shrinkage and selection operator (LASSO) regression analysis, and a prediction model was established, followed by internal validation of the model using the enhanced Bootstrap validation method. The performance of the model was evaluated using receiver operating characteristic curve and calibration curves. Finally, the clinical utility of the model was analyzed using decision curves and clinical impact curves.
RESULTS AND CONCLUSION: (1) Among the 365 patients included in this study, there were 33 recurrences (9.0%) after percutaneous endoscopic lumbar discectomy. (2) Six factors that were significantly associated with recurrence after percutaneous endoscopic lumbar discectomy were selected by LASSO regression, including age, operative segment, Modic changes, Pfirrmann classification, smoking history, and intense physical work. (3) The bias-corrected curve of the model fitted well with the apparent curve, with an area under the receiver operating characteristic curve of 0.909 and 95% confidence interval of (0.860-0.958). (4) The model has good clinical utility and is useful for clinicians to identify high-risk patients preoperatively and to individualize treatment.
Key words: percutaneous endoscopic lumbar discectomy, prediction model, LASSO regression analysis, recurrent lumbar disc herniation