Preoperative MRI Features and Outcomes for Lumbar Disc Herniation Treated with Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Study.

Percutaneous endoscopic lumbar discectomy (PELD) is widely used for lumbar disc herniation (LDH), yet outcomes vary. Preoperative magnetic resonance imaging (MRI) features may predict prognosis, but systematic research on their correlation with surgical efficacy is lacking. The purpose of this study is to retrospectively analyze the relationship between preoperative MRI morphological characteristics and clinical outcomes in patients receiving PELD treatment for lumbar disc herniation, with the aim of providing a reference for preoperative evaluation, outcome prediction, and surgical strategy optimization. In this retrospective study, 101 single-level LDH patients undergoing PELD (2022.1-2024.9) with ≥1-year follow-up were included. Preoperative MRI parameters [Pfirrmann grade, Modic changes, herniation type/location/migration, canal occupation ratio, disc height index (DHI)] and clinical outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab] were analyzed. Patients were grouped by 1-year MacNab scores. MRI features were compared between groups, with Pearson correlation and multivariate logistic regression used to identify predictors of a favorable prognosis. Of 101 patients, 76 (75.2%) had favorable outcomes and 25 (24.8%) unfavorable outcomes at 1-year follow-up. The unfavorable group showed significantly higher rates of disc extrusion/sequestration, larger herniation area, and Modic type II changes, but lower intervertebral height and foraminal area (P < 0.05). Canal occupation ratio and herniation area positively correlated with pain VAS and ODI, while DHI and foraminal area showed negative correlations. Modic type II changes independently predicted unfavorable prognosis, whereas DHI > 25% was a protective factor. Preoperative MRI features are closely associated with PELD outcomes, with Modic type II and reduced DHI identifying high-risk patients. This multidimensional MRI evaluation enables preoperative risk stratification and guides individualized surgical decision-making, including consideration of foraminoplasty or alternative approaches when adverse imaging features are present. Complete neural decompression, however, remains the ultimate determinant of success.