AIM: To provide deeper insights into the biological mechanisms underlying disc degeneration and recurrence by studying histopathological features of excised disc tissue. Moreover, due to limited predictive role of radiological grading systems like Pfirrmann and Modic classifications in understanding postoperative outcomes and recurrence mechanisms, to perform holistic analysis on clinical, patient specific factors, radiological and histological findings on matrix correlation statistics.

MATERIAL and METHODS: We conducted a retrospective study including 87 patients who underwent lumbar discectomy between 2019 and 2024. Detailed preoperative magnetic resonance imaging (MRI) evaluations using Pfirrmann grading, along with semi-quantitative histopathological analysis, were performed. Statistical analyses included Spearman correlation and ANOVA to explore relationships between clinical, radiological, and histopathological parameters.

RESULTS: Higher Pfirrmann grades were significantly associated with radiological instability (p<0.001). Histopathological analysis revealed that matrix disorganization was the only parameter significantly associated with clinical recurrence: all patients with recurrent disc herniation exhibited Grade 3 matrix disorganization (p<0.001), while only 40.5% of non-recurrent cases showed this pattern. Spearman correlation matrices further confirmed the absence of strong linear relationships among most individual clinical, radiological, and histological variables.

CONCLUSION: Our integrated approach underscores the importance of matrix disorganization as a biomarker for recurrence risk in lumbar disc herniation. In contrast, other histological features—such as chondrocyte grouping and cellularity—did not demonstrate consistent associations with clinical or radiological parameters. Radiological instability was reliably associated with advanced disc degeneration (higher Pfirrmann grades), but did not correlate with histopathological severity. This study advocates for personalized risk stratification tools integrating multi-dimensional data.