Clinical, anthropometric, and spinopelvic factors associated with insufficient functional recovery after percutaneous endoscopic lumbar discectomy in elderly patients: A prospective cohort study.

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) is widely used for elderly patients with lumbar disc herniation (LDH), yet some patients fail to achieve clinically meaningful functional recovery. Factors associated with insufficient recovery remain incompletely defined.ObjectiveTo evaluate approximately one-year functional outcomes after PELD in elderly patients with LDH and identify clinical, anthropometric, and spinopelvic factors associated with insufficient functional recovery.MethodsThis single-center prospective cohort study screened 325 consecutive patients undergoing single-level PELD for LDH between June 2023 and December 2024. After eligibility assessment and follow-up, 260 elderly patients with complete baseline and final follow-up data were analyzed. Functional outcomes were assessed using the Oswestry Disability Index (ODI) preoperatively and at 3, 6, and approximately 12 months postoperatively. Insufficient functional recovery was defined as an ODI improvement rate <30% at final follow-up. Univariable and multivariable logistic regression analyses were performed.ResultsOf 260 patients, 212 (81.5%) achieved adequate ODI improvement, whereas 48 (18.5%) had insufficient improvement. In the initial prespecified multivariable model, waist circumference remained associated with insufficient recovery (OR 1.10, 95% CI 1.04-1.17; P = 0.001). After adding preoperative pelvic tilt (PT), PT was independently associated with insufficient recovery (OR 1.19, 95% CI 1.02-1.39; P = 0.031), while the association of waist circumference was attenuated (OR 1.06, 95% CI 0.99-1.13; P = 0.121). In the exploratory extended model, diabetes, longer symptom duration, and severe radiographic degeneration remained associated with insufficient recovery, whereas waist circumference was further attenuated.ConclusionPELD provided favorable approximately one-year outcomes in most elderly patients with LDH. Insufficient recovery appears multifactorial. Waist circumference may serve as a clinically accessible risk marker, but diabetes, symptom duration, and severe degeneration showed more robust associations in exploratory analysis.