Burak BAHADIR, Fatma Betul SAYLAK, Mert YIGIT, Tunahan AKSAKALLI, Burcu OZALTIN, Omer Faruk TURKOGLU, Ramazan Azim OKYAY
The Atlantic Journal of Medical Science and Research - 2026;6(2):220-228
Aim: Cervical disc herniation (CDH) has traditionally been considered a degenerative disorder of middle-aged and elderly populations; however, recent epidemiological data indicate an increasing incidence among younger individuals. Although many young adult patients respond favorably to conservative treatment, a subset ultimately requires surgical intervention. Clinically applicable and evidence-based predictive tools tailored to this age group remain limited. This study aimed to identify independent predictors of surgical treatment requirement in young adult patients with CDH and to develop a prognostic nomogram for individualized risk estimation. Materials and Methods: This retrospective cohort study included 550 patients aged 18-40 years diagnosed with cervical disc herniation between January 2019 and December 2025. Clinical, demographic, lifestyle, and radiological variables were systematically collected. Variable importance was assessed using a Random Forest algorithm, and independent predictors were identified via multivariable logistic regression following multicollinearity evaluation using the variance inflation factor (VIF). A prognostic nomogram was constructed, and model performance was evaluated using receiver operating characteristic (ROC) analysis. Results: Surgical intervention was performed in 234 patients (42.5%). Increasing age, male sex, neurological deficit, myelopathy, trauma history, positive family history, and low physical activity were identified as independent predictors of surgical requirement. Radiological instability and pain severity were significant in univariable and machine learning analyses but were excluded from the final model due to multicollinearity. The model demonstrated good discriminative ability (AUC ? 0.83). However, its generalizability is limited by the retrospective single-center design and the absence of external validation. Conclusion: This study identifies independent determinants of surgical necessity in young adult patients with cervical disc herniation and proposes a prognostic nomogram for individualized risk stratification. The proposed model may support risk assessment and clinical decision-making in this population.
