Abstract：
Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m2) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.
摘要：
复发性腰椎间盘突出症（rLDH）是经皮内镜下腰椎间盘切除术（PELD）后最严重的并发症之一，也是导致手术失败和瘫痪的主要原因。文献中有关于识别与rLDH相关的危险因素的报道；然而，结果是有争议的。因此,我们进行了一项荟萃分析,以确定脊柱手术后患者发生rLDH的危险因素.PubMed,EMBASE,从开始至2018年4月,我们在Cochrane图书馆中检索了无语言限制的研究报告了PELD后LDH复发的危险因素.本荟萃分析遵循MOOSE指南。我们使用随机效应模型以95%置信区间(CI)汇总优势比(OR)。观察性研究的证据分为高质量（I类），中等质量(II/III类)，和低质量(IV类)基于总样本量的P值和研究之间的异质性。58项研究被确定，平均随访38.8个月。具有高质量（I类）证据的研究表明，PELD术后LDH复发与糖尿病显着相关（OR，1.64；95%CI，1.14至2.31），突起型LDH(或，1.62；95%CI，1.02至2.61），和经验较少的外科医生(或者，1.54；95%CI，1.10至2.16）。具有中等质量（II级或III级）证据的研究表明，术后LDH复发与高龄显着相关（OR，1.11；95%CI，1.05至1.19），修改更改(或，2.23；95%CI，1.53至2.29），吸烟(或,1.31；95%CI，1.00至1.71），没有大学教育(或者，1.56；95%CI，1.05至2.31），肥胖（BMI≥25kg/m2）（OR，1.66；95%CI，1.11至2.47），和不适当的体力劳动(或，2.18；95%CI，1.33至3.59）。根据目前的文献，8例患者相关危险因素和1例手术相关危险因素是PELD术后LDH复发的预测因素.这些发现可能有助于临床医生提高对PELD后LDH复发高危患者的早期干预意识。
