Rekürren lomber disk hernisinde radyolojik dejeneratif ilerlemenin rekürrens zamanlamasına etkisi: Retrospektif bir analiz

Öz

Amaç: Rekürren lomber disk hernisi (rLDH), lomber diskektomi sonrası önemli bir klinik sorundur. Herniyasyon boyutu ve kanal kompresyonu gibi yapısal faktörler araştırılmış olsa da, boylamsal dejeneratif ilerlemenin rekürrens zamanlaması üzerindeki etkisi net değildir. Bu çalışmada radyolojik dejenerasyon hızı ile yapısal kanal kompresyonunun erken ve geç rekürrens ile ilişkisi değerlendirildi. Gereç ve Yöntemler: 2011–2015 yılları arasında aynı seviyede rLDH nedeniyle revizyon cerrahisi uygulanan 50 hasta retrospektif olarak incelendi. Rekürrens süresine göre hastalar erken (≤12 ay) ve geç (>12 ay) olarak gruplandırıldı. Primer ve revizyon öncesi görüntülemelerde Pfirrmann derecesi, faset dejenerasyonu, Modic değişiklikleri ve lomber lordoz değerlendirildi. Dejenerasyon hızı (derece/yıl) hesaplandı. Aksiyel MRG’de kanal alanı ve herni alanı ölçüldü. Kaplan–Meier ve Cox regresyon analizleri uygulandı. Bulgular: Ortalama rekürrens süresi 9,41±5,2 ay olup rekürrenslerin %82’si ilk 12 ayda gelişti. Erken rekürrens grubunda Pfirrmann dejenerasyon hızı anlamlı derecede yüksekti (p<0,001). Çok değişkenli analizde dejenerasyon hızı erken rekürrens ile bağımsız olarak ilişkili bulundu (HR:2,18; %95 GA:1,32–3,60; p=0,003). Kanal alanı ve herni boyutu ile rekürrens zamanlaması arasında ilişki saptanmadı. Sonuç: Hızlanmış dejeneratif ilerleme, statik kompresyon şiddetinden daha belirgin biçimde erken rekürrens ile ilişkilidir. Boylamsal radyolojik değerlendirme, statik morfometrik ölçümlere kıyasla daha anlamlı prognostik bilgi sağlayabilir.

Anahtar Kelimeler

• Rekürren lomber disk hernisi
• disk dejenerasyonu
• pfirrmann sınıflaması
• spinal kanal kompresyonu
• rekürrens zamanı

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

Öz

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<0.001). In multivariable Cox analysis, increased degeneration velocity remained independently associated with shorter recurrence time (adjusted HR:2.18; 95% CI:1.32–3.60; p=0.003). Structural parameters were not associated with recurrence timing. Conclusion: Accelerated degenerative progression, rather than baseline compression magnitude, appears to influence recurrence timing in rLDH. Longitudinal radiological assessment may provide more meaningful prognostic information than static morphometric measurements.

Anahtar Kelimeler

• Recurrent lumbar disc herniation
• disc degeneration
• pfirrmann grading
• spinal canal compromise
• recurrence timing

Kaynakça

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