The effect of radiological degenerative progression on the timing of recurrence in recurrent lumbar disc herniation: A retrospective analysis

Abstract

Introduction: Recurrent lumbar disc herniation (rLDH) remains a significant complication following lumbar discectomy. While structural factors such as herniation size and canal compromise have been investigated, the impact of longitudinal degenerative progression on recurrence timing remains unclear. This study aimed to evaluate whether degeneration velocity or static canal compromise is associated with early versus late recurrence.Materials and Methods: Fifty patients who underwent revision surgery for same-level rLDH between 2011 and 2015 were retrospectively analyzed. Recurrence time was recorded, and patients were classified as early (≤12 months) or late (>12 months). Pre-primary and pre-revision imaging were evaluated for Pfirrmann grade, facet degeneration, Modic changes, and lumbar lordosis. Degeneration velocity (grades/year) was calculated. Spinal canal area and herniation area were measured on axial MRI. Kaplan–Meier survival analysis and Cox proportional hazards regression were performed.Results: The mean recurrence time was 9.41±5.2 months, with 82% occurring within the first year. Degeneration velocity was significantly higher in early recurrence cases (p