J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 6, June 2018, pages 486-492

Recurrence Is Associated With Body Mass Index in Patients Undergoing a Single-Level Lumbar Disc Herniation Surgery

Figure 1. To portray the size of disc herniation, the lesion is described as 1, 2, or 3 (a). In reference to the intra-facet line, a determination is made as to whether the disc herniation extends up to or less than 50% of the distance from the non-herniated posterior aspect of the disc to the intra-facet line (size-1), or more than 50% of that distance (size-2). If the herniation extends altogether beyond the intra-facet line, it is termed a size-3 disc. To further qualify location of the disc herniation, the lesion is described as central, lateral or far lateral (b).

Figure 2. Body mass index (BMI) individual values among the three groups of participants according to the presence of recurrence or not. Bars represent mean values. Group A: 50 patients with no recurrence and 11 patients with recurrence; group B: 101 patients with no recurrence and four patients with recurrence; group C: 86 patients with no recurrence and four patients with recurrence.

**Table 1.** Baseline Characteristics of Patients
	Upper disc levels (group A, n = 61, 23.8%)	L4-L5 (group B, n = 105, 41.0%)	L5-S1 (group C, n = 90, 35.1%)	P value
Data are presented as mean ± SD, otherwise is indicated. BMI: body mass index; L: lumbar; S: sacral; VAS: visual analog scale.
Age, years	55.8 ± 12.1	56.8 ± 12.7	53.4 ± 13.5	0.247
Sex (male), n (%)	35 (57.3)	56 (53.3)	47 (52.2)	0.814
BMI, kg/m²	23.1 ± 2.8	21.7 ± 2.2	22.1 ± 2.6	0.006
Surgical technique
Laminectomy (L), n(%)	21(34.4)	29 (27.6)	32 (35.5)	0.446
Partial laminectomy (PL) n (%),	5 (8.1)	24 (22.8)	10 (11.1)	0.016
Hemi laminectomy (HL) n (%),	8 (13.1)	13 (12.3)	6 (6.6)	0.328
Microdiscectomy (MD) n (%),	27 (44.2)	39 (37.1)	44 (48.8)	0.250
Diabetes, n (%)	10 (16.3)	11 (10.4)	8 (8.8)	0.338
Disc herniation size
Grade 1 lesions, n (%)	15 (24.5)	21 (20)	22 (24.4)	0.699
Grade 2 lesions, n (%)	24 (39.3)	41 (39.0)	36 (40)	0.991
Grade 3 lesions, n (%)	22 (36.0)	43 (40.9)	32 (35.5)	0.700
VAS preoperative	8.0 ± 0.8	7.9 ± 0.8	8.0 ± 0.8	0.513
Length of hospital stay, days	4.7 ± 0.8	4.5 ± 0.7	4.5 ± 0.8	0.049
Drop foot on admission, n (%)	0 (0)	3 (2.8)	0 (0)	0.113
Smoking, n (%)	27 (44.2)	33 (31.4)	36 (40)	0.214
Family history, n (%)	44 (72.1)	39 (37.1)	46 (51.1)	0.001
Location (far lateral), n (%)	13 (21.3)	9 (8.5)	4 (4.4)	0.003
History of injury to the lumbar spine, n (%)	16 (26.2)	9 (8.5)	9 (10)	0.003
Steroid use, n (%)	4 (6.5)	5 (4.7)	6 (6.6)	0.823

Table 1. Baseline Characteristics of Patients

Upper disc levels (group A, n = 61, 23.8%)

L4-L5 (group B, n = 105, 41.0%)

L5-S1 (group C, n = 90, 35.1%)

P value

Data are presented as mean ± SD, otherwise is indicated. BMI: body mass index; L: lumbar; S: sacral; VAS: visual analog scale.

Age, years

55.8 ± 12.1

56.8 ± 12.7

53.4 ± 13.5

0.247

Sex (male), n (%)

35 (57.3)

56 (53.3)

47 (52.2)

0.814

BMI, kg/m²

23.1 ± 2.8

21.7 ± 2.2

22.1 ± 2.6

0.006

Surgical technique

Laminectomy (L), n(%)

21(34.4)

29 (27.6)

32 (35.5)

0.446

Partial laminectomy (PL) n (%),

5 (8.1)

24 (22.8)

10 (11.1)

0.016

Hemi laminectomy (HL) n (%),

8 (13.1)

13 (12.3)

6 (6.6)

0.328

Microdiscectomy (MD) n (%),

27 (44.2)

39 (37.1)

44 (48.8)

0.250

Diabetes, n (%)

10 (16.3)

11 (10.4)

8 (8.8)

0.338

Disc herniation size

Grade 1 lesions, n (%)

15 (24.5)

21 (20)

22 (24.4)

0.699

Grade 2 lesions, n (%)

24 (39.3)

41 (39.0)

36 (40)

0.991

Grade 3 lesions, n (%)

22 (36.0)

43 (40.9)

32 (35.5)

0.700

VAS preoperative

8.0 ± 0.8

7.9 ± 0.8

8.0 ± 0.8

0.513

Length of hospital stay, days

4.7 ± 0.8

4.5 ± 0.7

4.5 ± 0.8

0.049

Drop foot on admission, n (%)

0 (0)

3 (2.8)

0 (0)

0.113

Smoking, n (%)

27 (44.2)

33 (31.4)

36 (40)

0.214

Family history, n (%)

44 (72.1)

39 (37.1)

46 (51.1)

0.001

Location (far lateral), n (%)

13 (21.3)

9 (8.5)

4 (4.4)

0.003

History of injury to the lumbar spine, n (%)

16 (26.2)

9 (8.5)

9 (10)

0.003

Steroid use, n (%)

4 (6.5)

5 (4.7)

6 (6.6)

0.823

**Table 2.** Outcomes of Patients
	Total	Group A, n = 61 (23.8%)	Group B, n = 105 (41.0%)	Group C, n = 90 (35.1%)	P value
Data are presented as n (%), otherwise is indicated. L: lumbar; S: sacral.
Recurrence, n (%)	19 (7.4)	11 (18)	4 (3.8)	4 (4.4)	0.001
Odom scale score
I	229 (89.4)	51 (83.6)	93 (88.5)	85 (94.4)	0.097
II	14 (5.4)	3 (4.9)	7 (6.6)	4 (4.4)	0.775
III	6 (2.3)	2 (3.2)	4 (3.8)	0 (0)	0.185
IV	7 (2.7)	5 (8.1)	1 (0.9)	1 (1.1)	0.011

Table 2. Outcomes of Patients

Total

Group A, n = 61 (23.8%)

Group B, n = 105 (41.0%)

Group C, n = 90 (35.1%)

P value

Data are presented as n (%), otherwise is indicated. L: lumbar; S: sacral.

Recurrence, n (%)

19 (7.4)

11 (18)

4 (3.8)

4 (4.4)

0.001

Odom scale score

229 (89.4)

51 (83.6)

93 (88.5)

85 (94.4)

0.097

14 (5.4)

3 (4.9)

7 (6.6)

4 (4.4)

0.775

III

6 (2.3)

2 (3.2)

4 (3.8)

0 (0)

0.185

7 (2.7)

5 (8.1)

1 (0.9)

1 (1.1)

0.011

**Table 3.** Univariate Analysis for Recurrence
Parameters	Recurrence, n = 19	No recurrence, n = 237	P value
Data are presented as mean ± SD, otherwise is indicated. BMI: body mass index; L: lumbar; S: sacral; VAS: visual analog scale.
BMI, kg/m²	26.0 ± 4.0	21.9 ± 2.3	0.001
Age, years	53.5 ± 13.2	55.5 ± 12.8	0.468
VAS preoperative	8.0 ± 0.8	7.9 ± 0.8	0.784
Length of hospital stay, days	4.7 ± 0.9	4.5 ± 0.7	0.314
Sex (male), n (%)	11 (57.8)	127 (53.5)	0.813
Surgical technique
Laminectomy (L), n (%)	7 (36.8)	75 (31.6)	0.619
Partial laminectomy (PL) n (%),	3 (15.7)	36 (15.1)	1.000
Hemi laminectomy (HL) n (%),	2 (10.5)	25 (10.5)	1.000
Microdiscectomy (MD) n (%),	7 (36.8)	103 (43.4)	0.637
Disc herniation size
Grade 1 lesions, n (%)	4 (21.0)	54 (22.7)	1.000
Grade 2 lesions, n (%)	11 (57.8)	90 (37.9)	0.094
Grade 3 lesions, n (%)	4 (21.0)	93 (39.2)	0.114
Diabetes, n (%)	2 (10.5)	27 (11.3)	1.000
Smoking, n (%)			0.461
Family history, n (%)	10 (5.2)	119 (50.2)	1.000
Location (far lateral), n (%)	4 (21.0)	22 (9.2)	0.112
History of injury to the lumbar spine, n (%)	7 (36.8)	27 (11.3)	0.006
Steroid use, n (%)	1 (5.2)	14 (5.9)	1.000

Table 3. Univariate Analysis for Recurrence

Parameters

Recurrence, n = 19

No recurrence, n = 237

P value

Data are presented as mean ± SD, otherwise is indicated. BMI: body mass index; L: lumbar; S: sacral; VAS: visual analog scale.

BMI, kg/m²

26.0 ± 4.0

21.9 ± 2.3

0.001

Age, years

53.5 ± 13.2

55.5 ± 12.8

0.468

VAS preoperative

8.0 ± 0.8

7.9 ± 0.8

0.784

Length of hospital stay, days

4.7 ± 0.9

4.5 ± 0.7

0.314

Sex (male), n (%)

11 (57.8)

127 (53.5)

0.813

Surgical technique

Laminectomy (L), n (%)

7 (36.8)

75 (31.6)

0.619

Partial laminectomy (PL) n (%),

3 (15.7)

36 (15.1)

1.000

Hemi laminectomy (HL) n (%),

2 (10.5)

25 (10.5)

1.000

Microdiscectomy (MD) n (%),

7 (36.8)

103 (43.4)

0.637

Disc herniation size

Grade 1 lesions, n (%)

4 (21.0)

54 (22.7)

1.000

Grade 2 lesions, n (%)

11 (57.8)

90 (37.9)

0.094

Grade 3 lesions, n (%)

4 (21.0)

93 (39.2)

0.114

Diabetes, n (%)

2 (10.5)

27 (11.3)

1.000

Smoking, n (%)

0.461

Family history, n (%)

10 (5.2)

119 (50.2)

1.000

Location (far lateral), n (%)

4 (21.0)

22 (9.2)

0.112

History of injury to the lumbar spine, n (%)

7 (36.8)

27 (11.3)

0.006

Steroid use, n (%)

1 (5.2)

14 (5.9)

1.000

**Table 4.** Multivariable Analysis (OR, 95% CI)
Name	OR	CI	P
BMI: body mass index; OR: odd ratio; CI: confidence interval; P: value for the difference between groups; pVAS: postoperative visual analog scale; Inj: history of injury to the lumbar spine.
History of injury to the lumbar spine	0.312	0.092 - 1.056	0.061
BMI	1.536	1.280 - 1.842	0.001

Table 4. Multivariable Analysis (OR, 95% CI)

Name

BMI: body mass index; OR: odd ratio; CI: confidence interval; P: value for the difference between groups; pVAS: postoperative visual analog scale; Inj: history of injury to the lumbar spine.

History of injury to the lumbar spine

0.312

0.092 - 1.056

0.061

BMI

1.536

1.280 - 1.842

0.001

**Table 5.** Statistical Findings for ROC
	Area	Std error	P value
BMI: body mass index; Rec: recurrence.
BMI-Rec	0.839	0.060	0.001
BMI-Odom I	0.597	0.065	0.099
BMI-Odom III	0.537	0.127	0.759
BMI-Odom IV	0.386	0.141	0.302

Table 5. Statistical Findings for ROC

Area

Std error

P value

BMI: body mass index; Rec: recurrence.

BMI-Rec

0.839

0.060

0.001

BMI-Odom I

0.597

0.065

0.099

BMI-Odom III

0.537

0.127

0.759

BMI-Odom IV

0.386

0.141

0.302