Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation

Abstract

Objective: We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy.Methods: We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH.Results: This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy.Conclusion: Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.

Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study

“…The most common cause of secondary surgery is known to be the recurrence of disc protrusion 16 . Factors such as age, gender, body mass index (BMI), smoking, and diabetes are known to contribute to the secondary surgery of LDH 33 , 34 . For LSS, secondary surgery is reported to occur at a rate of 11% to 18% between 8 and 10 years 13 , 35 , 36 .…”

Nomogram Development and Validation for Predicting Postoperative Recurrent Lumbar Disc Herniation Based on Paraspinal Muscle Parameters

“…As a local stabilizer, the multifidus muscle accounts for at least 2/3 of maintaining the stability of the “neutral zone”, and when the muscle degenerates, it will reduce the ability to control the neutral zone, and pain improvement does not necessarily mean multifidus muscle function recovery, but multifidus muscle atrophy may be related to recurrent LBP. 24 , 25 According to Zhu et al’s 26 study, PRLDH is more likely to occur when the multifidus muscle at the herniation site exhibits moderate to severe fatty infiltration. Studies have shown that the physiological cross-sectional area (PCSA) of the lumbar multifidus muscle is larger than that of the erector spinae, enabling it to generate more force.…”