The role of collagen pathologies and ligamentous laxity in lumbar disc herniation and its recurrence: a systematic review and meta-analysis

Collagen disorders and ligamentous laxity are associated with an increased risk of primary and recurrent LDH through combined molecular and mechanical mechanisms. These findings highlight the potential importance of connective tissue vulnerability in affected patients. While tailored interventions, including annular reinforcement, dynamic stabilization, and modified rehabilitation, may mitigate risk and improve outcomes, further research is required before routine genetic or biomechanical assessments can be incorporated into clinical evaluation or surgical planning.