BACKGROUND: Percutaneous transforaminal endoscopic discectomy is a minimally invasive technique for the treatment of lumbar disc herniation. It is widely accepted by patients, because it has the advantages of less trauma, more complete bone structure retention, and faster postoperative recovery. However, some patients are reported recurrence after percutaneous transforaminal endoscopic discectomy, and there are still controversies about the factors affecting its recurrence.
OBJECTIVE: To identify the risk factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy by meta-analysis
METHODS: A comprehensive search was conducted for the studies published until February 2020 on the factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy in the CNKI, Wanfang, VIP and CBM, PubMed, Cochrane Library and EMbase databases. Two or three evaluators independently searched, screened, extracted data, and included the documents meeting the inclusion criteria. Literature quality was assessed using Newcastle Ottawa scale score. Meta-analysis was carried out with RevMan 5.3 software.
RESULTS AND CONCLUSION: (1) A total of 606 articles were retrieved, and 11 studies were included after screening, including 7 high-quality articles and 4 medium-quality articles. (2) The recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy has nothing to do with sex, age, type of herniation, position, operative segment, operation program, drinking, hypertension, and hyperlipidemia (P > 0.05). (3) The recurrence is related to body mass index (OR=1.91, 95%CI: 1.20-3.04, P=0.006), Pfirrmann rating (OR=0.40, 95%CI: 0.19-1.87, P=0.02), removal of nucleus pulposus during operation (OR=3.17, 95%CI:1.51-6.69, P=0.002), fiber ring breakage (OR=1.93, 95%CI: 1.03-3.63, P=0.04), Modic change (OR=3.11, 95%CI: 1.87-5.18, P=0.04), diabetes mellitus (OR=2.06, 95%CI:1.12-3.77, P=0.02), and activity intensity (OR=4.45, 95%CI:2.65-7.48, P < 0.001). (4) These results suggest that body mass index, Pfirrmann rating, removal of nucleus pulposus during operation, fiber ring breakage, Modic change, smoking, diabetes mellitus and postoperative working intensity may be the risk factors for the recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic discectomy. However, the above conclusions need to be included in more high-quality literature for further study and verification.