title: Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy.
abstract: OBJECTIVE
  Few studies have addressed surgical failures and complications following percutaneous endoscopic lumbar discectomy (PELD), and no previous study has investigated the risk factors that lead to surgical failure. The authors report their experience using PELD for single-level lumbar disc herniation (LDH) to provide insights into the rates of surgical failure and identify potential risk factors that lead to this complication.
  
  
  METHODS
  The authors retrospectively reviewed the medical records of 350 patients who underwent PELD for single-level LDH and identified 36 patients (10.3%) who underwent reoperation due to the failure of PELD.
  
  
  RESULTS
  Patients' mean visual analog scale of pain scores and Oswestry Disability Index scores improved significantly from 6.6 ± 2.1 and 51.6 ± 19.4 preoperatively to 1.9 ± 1.4 and 28.3 ± 12.0, respectively, at 1 month postoperatively and 1.2 ± 1.1 and 9.3 ± 7.8, respectively, at 1 year postoperatively. The frequencies with which patients took analgesic medications significantly decreased from 74.6% preoperatively to 19.7% at 1 month postoperatively and 10.0% at 1 year postoperatively. Relatively older patients (p = 0.005) and those ≥ 60 years old (p = 0.001) experienced larger numbers of failures compared to younger patients. An analysis of potentially contributing comorbid conditions indicated that significantly more patients with diabetes were present in the PELD failure group (p = 0.017). As surgeons gained familiarity with the procedure, outcomes improved. The failure rate during the authors' early use of the PELD technique (Cases 1-70) was 17.1%; the failure rate then fell to 5.7% (p = 0.034) (Cases 141-210) before finally stabilizing at 10.0% (Cases 211-280 and Cases 281-350).
  
  
  CONCLUSIONS
  The surgical failure rate following PELD for LDH was 10.3%. Older patients, elderly patients (age ≥ 60 years), and patients with diabetes were at increased risk of surgical failure of PELD, particularly in the early years of the procedure's use.
authors.affiliation: Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning; and.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning; and.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning; and.
authors.forename: Liangbi
authors.initials: L
authors.lastname: Xiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017587:Diskectomy, Percutaneous / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: LDH = lumbar disc herniation; ODI = Oswestry Disability Index; PELD = percutaneous endoscopic lumbar discectomy; VAS = visual analog scale; lumbar disc herniation; minimally invasive spinal surgery; percutaneous endoscopic lumbar discectomy; risk factors; surgical failure