Araştırma Makalesi
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Evaluation of the Naples Score in Patients Undergoing Lumbar Disc Herniation Surgery: Its Role and Association with Impact on Postoperative Clinical Recovery

Yıl 2026, Cilt: 8 Sayı: 1, 110 - 118, 28.02.2026
https://doi.org/10.52827/hititmedj.1802992
https://izlik.org/JA72FU68XZ

Öz

Objective: This study aimed to evaluate the usability of the Naples Score as a systemic indicator of inflammation in patients with lumbar disc herniation and to investigate its possible association with surgical outcomes.
Materials and Methods: This single-center, prospective study included 73 patients who underwent microsurgical discectomy. Preoperative blood samples were analyzed for total cholesterol, serum albumin, neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio. Based on these parameters, patients were divided into three groups according to the Naples Score classification. Visual Analog Scale and Oswestry Disability Index scores were compared for all participants before surgery and at 45 days postoperatively.
Results:
The mean age of the participants was 50.5 ± 13.5 years, and 63% were female. The distribution of Naples Score groups was as follows: Group 1 (32.9%), Group 2 (34.2%), and Group 3 (32.9%). The mean preoperative Visual Analog Scale score decreased from 9.48 ± 0.75 to 2.04 ± 1.66 postoperatively. Similarly, the Oswestry Disability Index score declined from 81.19 ± 14.55 preoperatively to 17.28 ± 13.81 postoperatively. However, no statistically significant differences were found between the Naples Score groups in terms of changes in Visual Analog Scale and Oswestry Disability Index values (p > 0.05).
Conclusion:
The Naples Score may be a useful parameter for assessing systemic inflammation in patients with lumbar disc herniation. However, no significant association was found between preoperative Naples Score levels and postoperative improvement. These findings indicate that local and systemic inflammatory responses may differ biologically, warranting further multicenter studies with larger samples.

Etik Beyan

Ethical Approval: The study was conducted with the approval of the Ordu University Ethics Committee (Decision No: 2025/12-BAEK-06, Date: January 3, 2025).

Kaynakça

  • Chang X, Chen B, Li HY, et al. The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomized controlled trials. Int Orthop 2014;38:1225–1234.
  • Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391:2356–2367.
  • Wang Z, Zhao X, Li Y, et al. Development and validation of a multimodal feature fusion prognostic model for lumbar degenerative disease based on machine learning: a study protocol. BMJ Open 2023;13:e072139.
  • Ropper AH, Zafonte RD. Sciatica. N Engl J Med 2015;372:1240–1248.
  • Deyo RA, Mirza SK. Clinical practice: herniated lumbar intervertebral disc. N Engl J Med 2016;374:1763–1772.
  • Yu P, Mao F, Chen J, et al. Characteristics and mechanisms of resorption in lumbar disc herniation. Arthritis Res Ther 2022;24:205.
  • Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine (Phila Pa 1976) 1996;21(24 Suppl):2–9.
  • Zhou M, Theologis AA, O’Connell GD. Understanding the etiopathogenesis of lumbar intervertebral disc herniation: from clinical evidence to basic research. JOR Spine 2024;7:e1289.
  • Suyama K, Sakai D, Watanabe M. Role of IL-17-mediated inflammatory processes in the pathogenesis of intervertebral disc degeneration and herniation: a comprehensive review. Front Cell Dev Biol 2022;10:857164.
  • Cunha C, Silva AJ, Pereira P, et al. The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther 2018;20:251.
  • Firidin MN, Akyuz ME. Diagnostic efficiency of inflammatory prognostic index on pain scoring for degenerated intervertebral disc. Med Records Int Med J 2022;4(3):340–344.
  • Yılmaz A, Altaş H, Yıldırım T, et al. The clinical predictive value of the neutrophil to lymphocyte ratio as a biomarker in lumbar disc herniation. Middle Black Sea J Health Sci 2019;5(2):145–150.
  • Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum 2017;60:1273–1284.
  • Strong J, Ashton R, Chant D. Pain intensity measurement in chronic low back pain. Clin J Pain 1991;7:209–218.
  • Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–2952.
  • Garg A, Pathak H, Churyukanov MV, et al. Low back pain: critical assessment of various scales. Eur Spine J 2020;29:503–518.
  • Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004;29:581–585.
  • Parker SL, Godil SS, Mendenhall SK, et al. Two-year comprehensive medical management of degenerative lumbar spine disease: a value analysis of cost, pain, disability, and quality of life. J Neurosurg Spine 2014;21:143–149.
  • Lorio M, Kim C, Araghi A, et al. International Society for the Advancement of Spine Surgery Policy 2019: surgical treatment of lumbar disc herniation with radiculopathy. Int J Spine Surg 2020;14:1–17.
  • Bozyiğit B, Abbasoğlu B, Ünlüer C, et al. Microendoscopic discectomy for lumbar disc herniations: a series of 389 cases. Bakırköy Med J 2023;19:263–268.
  • Khan Z, Sharafat S, Ali H. Comparative analysis of success rates and complications between lumbar microdiscectomy and open discectomy for lumbar disc herniation. Pak J Med Sci 2025;41:992–996.
  • Arifin J, Gani KS, Kennedy D. Comparative effectiveness of microsurgery and endoscopic surgery in lumbar disc herniation: a systematic review and meta-analysis. Narra J 2025;5:e1214.
  • Lee CC, Lin RM, Juan WS, et al. Comparing clinical outcomes of microdiscectomy, interspinous device implantation, and full-endoscopic discectomy for simple lumbar disc herniation. J Clin Med 2025;14:1925.
  • Mehendiratta D, Patel P, Bhambhu V, et al. Effect of preoperative parameters on outcomes of lumbar microdiscectomy: a retrospective analysis. Asian J Neurosurg 2022;17:248–254.
  • Plasencia Arriba MÁ, Maestre C, Martín-Gorroño F, et al. Analysis of long-term results of lumbar discectomy with and without an interspinous device. Int J Spine Surg 2022;16:681–689.
  • Erario MLÁ, Croce E, Moviglia Brandolino MT, Moviglia G, Grangeat AM. Ozone as modulator of resorption and inflammatory response in extruded nucleus pulposus herniation: revising concepts. Int J Mol Sci 2021;22(18):9946.
  • Kim H, Hong JY, Lee J, et al. IL-1β promotes disc degeneration and inflammation through direct injection of intervertebral disc in a rat lumbar disc herniation model. Spine J 2021;21:1031–1041.
  • Li W, Gong Y, Liu J, et al. Peripheral and central pathological mechanisms of chronic low back pain: a narrative review. J Pain Res 2021;14:1483–1494.
  • de Souza Grava AL, Ferrari LF, Defino HL. Time-dependent effect of cytokine inhibition and inflammatory stimuli induced by nucleus pulposus on hyperalgesia. Eur Spine J 2012;21:537–545.
  • Francisco V, Pino J, González-Gay M, et al. An immunometabolic perspective on intervertebral disc degeneration. Nat Rev Rheumatol 2022;18:47–60.
  • Chen S, Liu S, Ma K, et al. TGF-β signaling in intervertebral disc health and disease. Osteoarthritis Cartilage 2019;27:1109–1117.
  • Li G, Lin J, Zhang H, et al. Knockdown of MIF-AS1 inhibits pain and inflammation in lumbar disc herniation by modulating the miR-185-5p/VEGFA axis. Global Spine J 2025;15:Online ahead of print.
  • Xiao L, Zhang Y, Xing Y, et al. CX3CR1 modulates acute disc herniation-induced pain via regulating local inflammation and spinal microglia activation. Osteoarthritis Cartilage 2025;33:Online ahead of print.
  • Liu X, Jiang T, Lu B. Effects of Xuefu Zhuyu Decoction on inflammatory factors and the NF-κB signaling pathway in a rat model of radicular pain. J Pain Res 2025;18:735–742.
  • Coquelet P, Da Cal S, El Hage G, et al. Specific plasma biomarker signatures associated with patients undergoing surgery for back pain. Spine J 2025;25(1):32-44.
  • Cuéllar JM, Borges PM, Cuéllar VG, et al. Cytokine expression in the epidural space: a model of noncompressive disc herniation-induced inflammation. Spine (Phila Pa 1976) 2013;38(1):17-23.
  • Rožac K, Matić A, Budrovac D, et al. Biological mechanisms of pain management in lumbar disk herniation: focus on cytokine correlations and therapeutic approaches. Int J Mol Sci 2025;26(22):10830.

Lomber Disk Hernisi Cerrahisi Geçiren Hastalarda Naples Skorunun Değerlendirilmesi: Postoperatif Klinik İyileşme Üzerindeki Etkisi ve İlişkisi

Yıl 2026, Cilt: 8 Sayı: 1, 110 - 118, 28.02.2026
https://doi.org/10.52827/hititmedj.1802992
https://izlik.org/JA72FU68XZ

Öz

Amaç: Bu çalışmada, lomber disk hernili hastalarda inflamasyonun sistemik bir göstergesi olarak Naples Skoru’nun kullanılabilirliği ve cerrahi sonuçlarla olası ilişkisi değerlendirildi.
Gereç ve Yöntem: Tek merkezli, prospektif olarak planlanan bu çalışmaya mikrocerrahi diskektomi uygulanan 73 hasta dâhil edildi. Preoperatif dönemde hastalardan alınan kan örneklerinde total kolesterol, serum albümin, nötrofil/lenfosit oranı ve lenfosit/monosit oranı değerlendirildi. Bu parametrelere göre hastalar Naples Skor sınıflamasına göre üç gruba ayrıldı. Tüm katılımcılarda cerrahi öncesi ve cerrahiden 45 gün sonraki dönemde Vizüel Analog Skala ve Oswestry Özürlülük İndeksi skorları karşılaştırıldı.
Bulgular: Katılımcıların yaş ortalaması 50,5±13,5 yıl olup, %63’ü kadındı. Naples Skor dağılımı Grup 1 (%32,9), Grup 2 (%34,2) ve Grup 3 (%32,9) olarak bulundu. Preoperatif dönemde ortalama Vizüel Analog Skala skoru 9,48±0,75 iken postoperatif dönemde 2,04±1,66’ya geriledi. Oswestry Özürlülük İndeksi skoru ise preoperatif dönemde 81,19±14,55’ten postoperatif dönemde 17,28±13,81’e düştü. Ancak Naples Skor grupları arasında Vizüel Analog Skala ve Oswestry Özürlülük İndeksi değerlerindeki değişim açısından istatistiksel olarak anlamlı fark saptanmadı (p>0,05).
Sonuç: Naples Skoru, lomber disk hernisi olan hastalarda sistemik inflamasyonun değerlendirilmesinde faydalı bir parametre olabilir. Ancak, ameliyat öncesi Naples Skoru seviyeleri ile ameliyat sonrası iyileşme arasında anlamlı bir ilişki bulunamamıştır. Bu bulgular, lokal ve sistemik inflamasyon yanıtlarının biyolojik olarak farklılık gösterebileceğini ve daha geniş örneklem gruplarıyla çok merkezli çalışmalar yapılmasını gerektirmektedir.

Etik Beyan

Etik Onay: Çalışma, Ordu Üniversitesi Etik Kurulu’nun onayı ile yürütülmüştür (Karar No: 2025/12-BAEK-06, Tarih: 3 Ocak 2025).

Kaynakça

  • Chang X, Chen B, Li HY, et al. The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomized controlled trials. Int Orthop 2014;38:1225–1234.
  • Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391:2356–2367.
  • Wang Z, Zhao X, Li Y, et al. Development and validation of a multimodal feature fusion prognostic model for lumbar degenerative disease based on machine learning: a study protocol. BMJ Open 2023;13:e072139.
  • Ropper AH, Zafonte RD. Sciatica. N Engl J Med 2015;372:1240–1248.
  • Deyo RA, Mirza SK. Clinical practice: herniated lumbar intervertebral disc. N Engl J Med 2016;374:1763–1772.
  • Yu P, Mao F, Chen J, et al. Characteristics and mechanisms of resorption in lumbar disc herniation. Arthritis Res Ther 2022;24:205.
  • Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine (Phila Pa 1976) 1996;21(24 Suppl):2–9.
  • Zhou M, Theologis AA, O’Connell GD. Understanding the etiopathogenesis of lumbar intervertebral disc herniation: from clinical evidence to basic research. JOR Spine 2024;7:e1289.
  • Suyama K, Sakai D, Watanabe M. Role of IL-17-mediated inflammatory processes in the pathogenesis of intervertebral disc degeneration and herniation: a comprehensive review. Front Cell Dev Biol 2022;10:857164.
  • Cunha C, Silva AJ, Pereira P, et al. The inflammatory response in the regression of lumbar disc herniation. Arthritis Res Ther 2018;20:251.
  • Firidin MN, Akyuz ME. Diagnostic efficiency of inflammatory prognostic index on pain scoring for degenerated intervertebral disc. Med Records Int Med J 2022;4(3):340–344.
  • Yılmaz A, Altaş H, Yıldırım T, et al. The clinical predictive value of the neutrophil to lymphocyte ratio as a biomarker in lumbar disc herniation. Middle Black Sea J Health Sci 2019;5(2):145–150.
  • Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum 2017;60:1273–1284.
  • Strong J, Ashton R, Chant D. Pain intensity measurement in chronic low back pain. Clin J Pain 1991;7:209–218.
  • Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–2952.
  • Garg A, Pathak H, Churyukanov MV, et al. Low back pain: critical assessment of various scales. Eur Spine J 2020;29:503–518.
  • Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004;29:581–585.
  • Parker SL, Godil SS, Mendenhall SK, et al. Two-year comprehensive medical management of degenerative lumbar spine disease: a value analysis of cost, pain, disability, and quality of life. J Neurosurg Spine 2014;21:143–149.
  • Lorio M, Kim C, Araghi A, et al. International Society for the Advancement of Spine Surgery Policy 2019: surgical treatment of lumbar disc herniation with radiculopathy. Int J Spine Surg 2020;14:1–17.
  • Bozyiğit B, Abbasoğlu B, Ünlüer C, et al. Microendoscopic discectomy for lumbar disc herniations: a series of 389 cases. Bakırköy Med J 2023;19:263–268.
  • Khan Z, Sharafat S, Ali H. Comparative analysis of success rates and complications between lumbar microdiscectomy and open discectomy for lumbar disc herniation. Pak J Med Sci 2025;41:992–996.
  • Arifin J, Gani KS, Kennedy D. Comparative effectiveness of microsurgery and endoscopic surgery in lumbar disc herniation: a systematic review and meta-analysis. Narra J 2025;5:e1214.
  • Lee CC, Lin RM, Juan WS, et al. Comparing clinical outcomes of microdiscectomy, interspinous device implantation, and full-endoscopic discectomy for simple lumbar disc herniation. J Clin Med 2025;14:1925.
  • Mehendiratta D, Patel P, Bhambhu V, et al. Effect of preoperative parameters on outcomes of lumbar microdiscectomy: a retrospective analysis. Asian J Neurosurg 2022;17:248–254.
  • Plasencia Arriba MÁ, Maestre C, Martín-Gorroño F, et al. Analysis of long-term results of lumbar discectomy with and without an interspinous device. Int J Spine Surg 2022;16:681–689.
  • Erario MLÁ, Croce E, Moviglia Brandolino MT, Moviglia G, Grangeat AM. Ozone as modulator of resorption and inflammatory response in extruded nucleus pulposus herniation: revising concepts. Int J Mol Sci 2021;22(18):9946.
  • Kim H, Hong JY, Lee J, et al. IL-1β promotes disc degeneration and inflammation through direct injection of intervertebral disc in a rat lumbar disc herniation model. Spine J 2021;21:1031–1041.
  • Li W, Gong Y, Liu J, et al. Peripheral and central pathological mechanisms of chronic low back pain: a narrative review. J Pain Res 2021;14:1483–1494.
  • de Souza Grava AL, Ferrari LF, Defino HL. Time-dependent effect of cytokine inhibition and inflammatory stimuli induced by nucleus pulposus on hyperalgesia. Eur Spine J 2012;21:537–545.
  • Francisco V, Pino J, González-Gay M, et al. An immunometabolic perspective on intervertebral disc degeneration. Nat Rev Rheumatol 2022;18:47–60.
  • Chen S, Liu S, Ma K, et al. TGF-β signaling in intervertebral disc health and disease. Osteoarthritis Cartilage 2019;27:1109–1117.
  • Li G, Lin J, Zhang H, et al. Knockdown of MIF-AS1 inhibits pain and inflammation in lumbar disc herniation by modulating the miR-185-5p/VEGFA axis. Global Spine J 2025;15:Online ahead of print.
  • Xiao L, Zhang Y, Xing Y, et al. CX3CR1 modulates acute disc herniation-induced pain via regulating local inflammation and spinal microglia activation. Osteoarthritis Cartilage 2025;33:Online ahead of print.
  • Liu X, Jiang T, Lu B. Effects of Xuefu Zhuyu Decoction on inflammatory factors and the NF-κB signaling pathway in a rat model of radicular pain. J Pain Res 2025;18:735–742.
  • Coquelet P, Da Cal S, El Hage G, et al. Specific plasma biomarker signatures associated with patients undergoing surgery for back pain. Spine J 2025;25(1):32-44.
  • Cuéllar JM, Borges PM, Cuéllar VG, et al. Cytokine expression in the epidural space: a model of noncompressive disc herniation-induced inflammation. Spine (Phila Pa 1976) 2013;38(1):17-23.
  • Rožac K, Matić A, Budrovac D, et al. Biological mechanisms of pain management in lumbar disk herniation: focus on cytokine correlations and therapeutic approaches. Int J Mol Sci 2025;26(22):10830.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Beyin ve Sinir Cerrahisi (Nöroşirurji)
Bölüm Araştırma Makalesi
Yazarlar

Bekir Tunç 0000-0002-1941-0515

Ömer Faruk Şahin 0000-0003-2430-4650

Gönderilme Tarihi 13 Ekim 2025
Kabul Tarihi 15 Aralık 2025
Yayımlanma Tarihi 28 Şubat 2026
DOI https://doi.org/10.52827/hititmedj.1802992
IZ https://izlik.org/JA72FU68XZ
Yayımlandığı Sayı Yıl 2026 Cilt: 8 Sayı: 1

Kaynak Göster

AMA 1.Tunç B, Şahin ÖF. Lomber Disk Hernisi Cerrahisi Geçiren Hastalarda Naples Skorunun Değerlendirilmesi: Postoperatif Klinik İyileşme Üzerindeki Etkisi ve İlişkisi. Hitit Medical Journal. 2026;8(1):110-118. doi:10.52827/hititmedj.1802992