Nomogram for prediction of recurrence in patients with lumbar disc herniation after unilateral biportal endoscopy spinal surgery: a retrospective study

Yi Rong; Kaixuan Wang; Yalan Pan; Tianchi Zhang; Yong Ma; Lining Wang; Yang Guo; Si Chen; Yang Shao; Tingchen Zhu; Shixiang Wu; Zhen Hua; Jianwei Wang; Hao Yu

doi:10.3389/fsurg.2025.1564825

Nomogram for prediction of recurrence in patients with lumbar disc herniation after unilateral biportal endoscopy spinal surgery: a retrospective study

Front Surg. 2025 Jun 16:12:1564825. doi: 10.3389/fsurg.2025.1564825. eCollection 2025.

Authors

Yi Rong^#¹, Kaixuan Wang^#², Yalan Pan^#^{3

4}, Tianchi Zhang³, Yong Ma^{2

3

5

6}, Lining Wang^{2

3

7}, Yang Guo^{3

7}, Si Chen¹, Yang Shao¹, Tingchen Zhu¹, Shixiang Wu¹, Zhen Hua^{1

6}, Jianwei Wang¹, Hao Yu¹

Affiliations

¹ Department of Traumatology & Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China.
² School of Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
³ Laboratory of New Techniques of Restoration & Reconstruction, Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.
⁴ School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
⁵ Yancheng Hospital of Traditional Chinese Medicine, Yancheng Affiliated Hospital of Nanjing University of Chinese Medicine, Yancheng, China.
⁶ Jiangsu CM Clinical Innovation Center of Degenerative Bone & Joint Disease, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, China.
⁷ Department of Orthopedic Surgery, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.

^# Contributed equally.

Abstract

Objective: This study aimed to construct a nomogram to predict the likelihood of early recurrence in patients with lumbar disc herniation (LDH) following unilateral biportal endoscopic (UBE) surgery.

Methods: A retrospective analysis was conducted on LDH patients who underwent UBE surgery in our department between January 1, 2022, and December 31, 2023. The eligible cohort was randomly divided into training and validation sets in a 7:3 ratio. Key predictors for the nomogram were identified through a combination of least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis. The model's performance was assessed using the C-index, the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. The validation set was used to further evaluate the model's robustness.

Results: A total of 289 patients were included in the study, among whom 50 experienced recurrent LDH (rLDH). Five risk factors were identified as significant predictors for rLDH: width of protrusion base (WPB), bone removal range (BRR), Modic changes, type of LDH, and middle vertebral space height (MVH). The C-index values for the training and validation sets were 0.834 and 0.804, respectively. The AUC values were 0.834 (95% CI: 0.750-0.918) in the training set and 0.804 (95% CI: 0.697-0.910) in the validation set. Calibration curves demonstrated excellent concordance between the predicted and observed outcomes. Decision curve analysis indicated that using the nomogram to predict rLDH risk provided a positive net benefit when the threshold probability was between 4% and 63%.

Conclusion: This study successfully developed and validated a nomogram to predict early recurrence in LDH patients following UBE surgery. The model provides a valuable tool for clinicians to assess individual rLDH risk, enabling timely interventions to improve postoperative outcomes.

Keywords: LDH; UBE; nomogram; prediction model; recurrence.