SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
A Meta-Analysis of Risk Factors for Recurrence Following Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation
Abuduwupuer Haibier 1
Gao Ruihuan 2
Wei Liu 3
Guanghui Wang 3
1. Xinjiang Medical University, Ürümqi, China
2. Tarim University, Aral, China
3. Shenzhen Second People's Hospital, Shenzhen, China
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Abstract
Objective: This meta-analysis aimed to identify risk factors associated with postoperative recurrence following Percutaneous Endoscopic Lumbar Discectomy (PELD) for Lumbar Disc Herniation (LDH). Methods: We systematically searched PubMed, the Cochrane Library, EMbase, CNKI, WanFang, and VIP databases for case-control and cohort studies investigating risk factors for recurrence after PELD, from their inception until August 30, 2025. Two reviewers independently extracted data and assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Stata 12.0 software to calculate the pooled odds ratios (OR) and 95% confidence intervals (CI) for each potential factor. Results: A total of 39 case-control studies, involving 14,454 patients, were included. The overall postoperative recurrence rate was 11.0% (95% CI: 9.1%–13.0%). Factors significantly associated with an increased risk of recurrence included: Modic changes (OR = 1.74, 95% CI: 1.25–2.23), particularly type II Modic changes (OR = 1.87, 95% CI: 1.02–2.72); diabetes mellitus (OR = 2.34, 95% CI: 1.52–3.59); smoking (OR = 2.02, 95% CI: 1.27–3.21); intraoperative annulus fibrosus rupture (OR = 2.40, 95% CI: 1.28–4.49); greater sagittal range of motion (SROM) (OR = 2.00, 95% CI: 1.58–2.53); higher body mass index (BMI) (OR = 1.30, 95% CI: 1.18–1.42); advanced age (OR = 1.21, 95% CI: 1.12–1.30); and high-intensity postoperative activity (OR = 1.83, 95% CI: 1.23–2.44). Among the herniation types, sequestrated disc herniation was associated with the highest recurrence risk. No significant correlation was found between the Pfirrmann grading system and recurrence risk (OR = 1.28, 95% CI: 0.95–1.60). Conclusion: The results of this meta-analysis indicate that recurrence after PELD for LDH is associated with a range of factors. Significant independent patient-related risk factors include advanced age, higher BMI, smoking, diabetes, and the presence of Modic changes (especially type II). Regarding surgical factors, intraoperative annulus fibrosus rupture significantly increases the risk of recurrence. Postoperatively, engaging in high-intensity activities too early or having a greater lumbar SROM also markedly elevates the probability of recurrence.
Summary
Keywords
Lumbar disc herniation, Meta-analysis, Percutaneous endoscopic lumbar discectomy, Recurrence, Risk factors
Received
28 October 2025
Accepted
17 February 2026
Copyright
© 2026 Haibier, Ruihuan, Liu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Abuduwupuer Haibier; Guanghui Wang
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