[Objective]To explore the factors related to recurrent lumbar disc herniation(rLDH)after percutaneous endoscopic lumbar discectomy(PELD)and establish a predicting model.[Methods]A retrospective study was conducted on 286 patients who underwent PELD for lumbar disc herniation in our hospital from January 2017 to January 2020.Based on whether rLDH happened within 3 years after the pri-mary PELD,the patients were fell into the recurrence group and non-recurrence group.Univariate comparison and multiple logistic regres-sion analysis were performed to search the factors related to the recurrence,establish a mathematical predicting model and draw a Nomogram figure.Then,receiver operating characteristic(ROC)curve,and relative analysis were used to evaluate the clinical significance of this mod-el.[Results]Among the 286 patients,44 patients were diagnosed of rLDH,accounting for 15.4％,while the remaining 242 patients were con-firmed as the non-rLDH,accounting for 84.6％.Regarding univariate comparison,the rLDH group was significantly greater than the non-rLDH group in terms of BMI[(25.8±3.0)vs(24.2±3.3),P=0.004]and course of disease[(17.9±18.3)months vs(10.7±16.8)months,P=0.009].In addition,the rLDH group had significantly more Modic change in preoperative images than the non-rLDH group[no/yes,(30/14)vs(206/36),P=0.006],the former got significantly greater range of motion(ROM)in the affected segment measured on preoperative radiographs than the latter[(9.3±3.4)° vs(7.1±2.8)°,P＜0.001].Moreover,the rLDH group had significantly higher ratio the transforaminal approach than the non-rLDH group[transforaminal/interlaminar,(29/15)vs(118/124),P=0.036].As results of logistic regression,the BMI(OR=1.154,95％CI 1.031～1.291,P=0.013),disease course(OR=1.023,95％CI 1.005～1.042,P=0.013),Modic changes(OR=3.143,95％CI 1.369～7.070,P=0.007),intervertebral ROM(OR=1.264,95％CI 1.126～1.419,P＜0.001)and surgical approach ratio(foraminal/interlaminar)(OR=2.104,95％CI 1.007～4.396,P=0.048)were independent risk factors for recurrence.The predicting model obtained by logistic regression got area under the curve(AUC)of 0.787(95％CI 0.721～0.853)by ROC analysis,is in good agreement with the actual curve,and a large net benefit with risk threshold between 10％～50％by decision curve analysis(DCA).[Conclusion]In this study,the BMI,disease course,preoperative Modic changes,preoperative intervertebral ROM and surgical approach were risk factors for rLDH after PELD,while this predicting mode might be helpful for clinicians to determine the risk of recurrence after surgery.
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