A single-source preoperative prediction model for recurrent lumbar disc herniation after primary discectomy…

Cohort studyNorth American Spine Society journal· Sep 2026

A single-source preoperative prediction model for recurrent lumbar disc herniation after primary discectomy: Development and internal validation in the SPORT registry.

Bilal Ibrahim, Qais A Samara, Waleed F Dabbas … Abdallah Arabyat

SpineCohort studyQ1IF 3.2

Preoperative model predicted recurrent disc herniation with acceptable discrimination, AUC 0.738

A single-source preoperative prediction model for recurrent lumbar disc herniation after primary discectomy: Development and internal validation in the SPORT registry.

Bilal Ibrahim … Abdallah Arabyat

North American Spine Society journal · Sep 2026 · Q1 in Surgery

Background

Recurrent lumbar disc herniation (rLDH) follows primary discectomy in 5% to 25% of patients.

Purpose

We aimed to develop and internally validate a strictly preoperative model for rLDH using a single multi-center registry, with calibration-first evaluation, decision curve analysis, and a SHAP-aligned clinical score (SHapley Additive exPlanations).

Methods

This retrospective development and split-sample internal validation study used the Spine Patient Outcomes Research Trial (Spine Patient Outcomes Research Trial) lumbar disc herniation cohort; 738 of 1,244 enrolled patients met inclusion criteria.

n = 110 patients

Results

AUROC, 1.0 is perfect; model discriminated recurrence risk reasonably well

AUC 0.74 (95% CI 0.69 to 0.78)

null 0

0.69

0.78

CI excludes the null - significant

More results

Recurrence occurred in 110 patients (14.9%).

SHAP identified annular defect size, smoking, and younger age as the most influential predictors.

A 10-item score stratified patients into low- (5.8%), moderate- (15.2%), and high-risk (32.6%) groups.

More results

Decision curve analysis showed net benefit across threshold probabilities of 8% to 30%.

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Conclusion · 1 of 2

A timing-consistent, single-registry preoperative model achieved acceptable discrimination and calibration for rLDH.

Conclusion · 2 of 2

The SHAP-aligned score offers transparent preoperative risk stratification; external validation is required before clinical use.

A single-source preoperative prediction model for recurrent lumbar disc herniation after primary discectomy: Development and internal validation in the SPORT registry.

A single-source preoperative prediction model for recurrent lumbar disc herniation after primary discectomy: Development and internal validation in the SPORT registry.

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