Association of preoperative Pfirrmann grade with 12-month outcomes after interlaminar full-endoscopic lumbar discectomy with successful annular suture repair: a single-center retrospective cohort study.
- 1Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Abstract
Background
Whether advanced disc degeneration affects outcomes after annular suture repair remains uncertain. This study evaluated the association of Pfirrmann grade IV with 12-month outcomes and MRI-confirmed symptomatic recurrence among selected patients undergoing interlaminar full-endoscopic lumbar discectomy with successful annular suture repair.Methods
This single-center retrospective cohort included 226 patients treated between May 2023 and March 2025. Patients were classified as Pfirrmann grades I-III (n = 151) or grade IV (n = 75). The primary estimands were ATT-IPTW-adjusted between-group differences in VAS-back, VAS-leg, and ODI at 12 months. Weighted generalized estimating equations assessed longitudinal trajectories. Modified MacNab outcomes and MRI-confirmed symptomatic recurrence were secondary outcomes; postoperative MRI was symptom-triggered.Results
At 12 months, adjusted grade IV-minus-grades I-III differences were 0.070 for VAS-back (95% CI, -0.270-0.409), -0.005 for VAS-leg (95% CI, -0.334-0.325), and 0.297 for ODI (95% CI, -1.180-1.774). Results were consistent in propensity-score-matched, grades III-IV restricted, and ordinal sensitivity analyses. Excellent/good modified MacNab outcomes occurred in 93.4% and 92.0% of patients, respectively. MRI-confirmed symptomatic recurrence occurred in 6/151 and 2/75 patients. Recurrence analyses were exploratory because only eight events occurred.Conclusions
Among selected patients with successful annular suture repair, Pfirrmann grade IV was not associated with a clinically important disadvantage in 12-month pain or functional outcomes. No increased recurrence signal was observed, but the study cannot determine whether Pfirrmann grade affects surgical candidacy, repairability, or successful closure.
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BibTeX
@article{zhou2026association,
title = {{Association of preoperative Pfirrmann grade with 12-month outcomes after interlaminar full-endoscopic lumbar discectomy with successful annular suture repair: a single-center retrospective cohort study.}},
author = {Lei Zhou and Haoyun Huang and Song Zhu and Xin Chen and Yunchuan Gou and Jikun Sun and Pin Xie and Yi Zhou and Rigao Chen},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1924468},
url = {https://europepmc.org/article/MED/42923219},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of preoperative Pfirrmann grade with 12-month outcomes after interlaminar full-endoscopic lumbar discectomy with successful annular suture repair: a single-center retrospective cohort study.
AU - Lei Zhou
AU - Haoyun Huang
AU - Song Zhu
AU - Xin Chen
AU - Yunchuan Gou
AU - Jikun Sun
AU - Pin Xie
AU - Yi Zhou
AU - Rigao Chen
PY - 2026
DA - 2026/10/08
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1924468
UR - https://europepmc.org/article/MED/42923219
AB - Background Whether advanced disc degeneration affects outcomes after annular suture repair remains uncertain. This study evaluated the association of Pfirrmann grade IV with 12-month outcomes and MRI-confirmed symptomatic recurrence among selected patients undergoing interlaminar full-endoscopic lumbar discectomy with successful annular suture repair.Methods This single-center retrospective cohort included 226 patients treated between May 2023 and March 2025. Patients were classified as Pfirrmann grades I-III (n = 151) or grade IV (n = 75). The primary estimands were ATT-IPTW-adjusted between-group differences in VAS-back, VAS-leg, and ODI at 12 months. Weighted generalized estimating equations assessed longitudinal trajectories. Modified MacNab outcomes and MRI-confirmed symptomatic recurrence were secondary outcomes; postoperative MRI was symptom-triggered.Results At 12 months, adjusted grade IV-minus-grades I-III differences were 0.070 for VAS-back (95% CI, -0.270-0.409), -0.005 for VAS-leg (95% CI, -0.334-0.325), and 0.297 for ODI (95% CI, -1.180-1.774). Results were consistent in propensity-score-matched, grades III-IV restricted, and ordinal sensitivity analyses. Excellent/good modified MacNab outcomes occurred in 93.4% and 92.0% of patients, respectively. MRI-confirmed symptomatic recurrence occurred in 6/151 and 2/75 patients. Recurrence analyses were exploratory because only eight events occurred.Conclusions Among selected patients with successful annular suture repair, Pfirrmann grade IV was not associated with a clinically important disadvantage in 12-month pain or functional outcomes. No increased recurrence signal was observed, but the study cannot determine whether Pfirrmann grade affects surgical candidacy, repairability, or successful closure.
SN - 2296-875X
ER -