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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (3): 537-542. doi: 10.19723/j.issn.1671-167X.2023.03.021

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Influential factors related to functional status after full-endoscopic lumbar discectomy

Wei ZHU1,Bin ZHU1,2,*(),Xiao-guang LIU1   

  1. 1. Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, China
    2. Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2020-07-10 Online:2023-06-18 Published:2023-06-12
  • Contact: Bin ZHU E-mail:zhubin@bjmu.edu.cn
  • Supported by:
    Central Health Research Project Fund(W2017BJ53);National Key Research and Development Plan(2017YFC0108101);Hospital Level Fund of Peking University Third Hospital(Y77451-02)

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Abstract:

Objective: To explore the influential factors associated with functional status of those patients who undertook a full-endoscopic lumbar discectomy operation. Methods: A prospective study was conducted. A total of 96 patients who undertook a full-endoscopic lumbar discectomy operation and met inclusive criteria were enrolled in the study. The postoperative follow-up was held 1 month, 3 months and 6 months after operation. The self-developed record file was used to collect the patient's information and medical history. Visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Gene-ralised anxiety disorder-7 (GAD-7) scale score and patient health questionnaire-9 (PHQ-9) scale score were applied to measure pain intensity, functional status, anxiety status and depression status. Repeated measurement analysis of variance was used to explore the ODI score 1 month, 3 months and 6 months after operation. Multiple linear regression was recruited to illuminate the influential factors associated with functional status after the operation. Logistic regression was employed to explore the independent risk factors related to return to work 6 months after operation. Results: The postoperative functional status of the patients improved gradually. The functional status of the patients 1 month, 3 months and 6 months after operation were highly positively correlated with the current average pain intensity. The factors influencing the postoperative functional status of the patients were different according to the recovery stage. One month and 3 months after operation, the factors influencing the postoperative functional status were the current average pain intensity; 6 months after operation, the factors influencing the postoperative functional status included the current average pain intensity, preoperative average pain intensity, gender and educational level. The risk factors influencing return to work 6 months after operation included women, young age, preoperative depression status and high average pain intensity 3 months after operation. Conclusion: It is feasible to treat chronic low back pain with full-endoscopic lumbar discectomy operation. In the process of postoperative functional status recovery, medical staffs should not only take analgesic mea-sures to reduce the pain intensity experienced by the patients, but also pay attention to the impact of psychosocial factors on the recovery. Women, young age, preoperative depression status, and high average pain intensity 3 months after operation may delay return to work after the operation.

Key words: Discectomy, Endoscopy, Lumbar vertebrae, Intervertebral disc displacement, Risk factors

CLC Number: 

  • R681.53

Figure 1

Repeated measurement analysis of variance of ODI at preoperation and postoperation (1-, 3-, 6-month) (n=96) ODI, Oswestry disability index."

Table 1

Comparison of postoperative ODI (1-, 3-, 6-month) by different clinical features in patients (n=96)"

Items 1-month after operation 3-month after operation 6-month after operation
ODI t/F P ODI t/F P ODI t/F P
Gender -2.08 0.041 -2.39 0.021 -2.53 0.014
  Male (n=52) 0.50±0.10 0.29±0.16 0.16±0.13
  Female (n=44) 0.56±0.15 0.38±0.19 0.23±0.15
Marital status 0.17 0.867 0.30 0.791 0.33 0.722
  Married (n=80) 0.53±0.13 0.33±0.18 0.20±0.14
  Single or divorced (n=16) 0.52±0.13 0.32±0.21 0.18±0.13
Rescource of medical cost 0.71 0.496 -0.16 0.883 -0.55 0.538
  Medical insurance (n=82) 0.52±0.13 0.33±0.18 0.20±0.14
  Non medical insurance (n=14) 0.55±0.13 0.32±0.20 0.17±0.11
Medical history 0.64 0.532 -0.04 0.962 1.26 0.228
  Yes (n=17) 0.55±0.13 0.33±0.14 0.23±0.14
  No (n=79) 0.52±0.13 0.33±0.19 0.19±0.14
Smoking 0.02 0.987 -0.41 0.695 0.47 0.637
  Yes (n=26) 0.53±0.13 0.34±0.19 0.18±0.14
  No (n=70) 0.53±0.13 0.32±0.18 0.20±0.14
Alcohol -0.02 0.982 0.50 0.585 0.25 0.780
  Yes (n=81) 0.53±0.09 0.31±0.16 0.19±0.11
  No (n=15) 0.53±0.14 0.33±0.19 0.20±0.15
Analgesics 0.44 0.662 -0.80 0.422 -0.43 0.670
  No (n=40) 0.53±0.13 0.31±0.19 0.19±0.14
  Yes (n=56) 0.52±0.13 0.35±0.18 0.20±0.14
Educational level 2.19 0.094 1.02 0.386 5.56 0.002
  Middle school and lower (n=32) 0.51±0.14 0.33±0.19 0.14±0.10
  High school (n=20) 0.52±0.11 0.30±0.18 0.19±0.13
  Diploma (n=27) 0.50±0.11 0.30±0.16 0.19±0.13
  Bachelor degree and above (n=17) 0.60±0.14 0.39±0.21 0.30±0.18

Table 2

Factors associated with post-operative ODI (1-, 3-, 6-month) by correlation factor analysis (n=96)"

Items Age PHQ-9 at preoperation GAD-7 at preoperation Average VAS at preoperation Average VAS on current
r P r P r P r P r P
ODI (1-month) 0.13 0.208 0.19 0.08 0.465 0.060 0.16 0.110 0.65 < 0.001
ODI (3-month) 0.12 0.260 0.18 0.04 0.675 0.085 0.16 0.127 0.70 < 0.001
ODI (6-month) 0.25 0.014 0.21 0.18 0.086 0.036 0.18 0.081 0.69 < 0.001

Table 3

Factors associated with post-operative ODI at 1-, 3-, 6-month by multiple linear regression analysis (n=96)"

Dependent variable Independent variable β t P VIF R2 D-W
ODI (1-month) VAS (1-month) 0.65 8.24 < 0.001 1.00 41.9% 2.28
ODI (3-month) VAS (3-month) 0.70 9.60 < 0.001 1.00 49.5% 2.11
ODI (6-month) VAS (6-month) 0.64 9.28 < 0.001 1.03 58.2% 1.93
VAS (preoperation) 0.16 2.33 0.022 1.01
Gender 0.15 2.17 0.032 1.03
Educational level 0.22 3.14 0.002 1.04

Table 4

Impacts of the various factors on patients' return to work at 6-month post-operation (Logistic regression, n=96)"

Variables B Wald P OR 95%CI for OR
Gender 2.41 7.05 0.008 11.12 1.88-65.81
Age -0.10 5.79 0.016 0.91 0.84-0.98
PHQ-9 at preoperation 0.16 5.59 0.018 1.18 1.03-1.35
Average VAS at 3-month postoperation 0.47 7.09 0.008 1.60 1.13-2.26
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