Preoperative Spinopelvic Alignment in Recurrent Versus Non-Recurrent Lumbar Disc Herniation: A Comparative Cohort Study

This study aimed to evaluate the association between preoperative spinopelvic alignment parameters and recurrent lumbar disc herniation (RLDH) and assess their value in potentially predicting recurrence following surgery. A retrospective cohort of 117 patients who underwent single-level lumbar discectomy between 2015 and 2018 was analyzed. The RLDH group included 62 patients who required reoperation due to recurrence, whereas the control group consisted of 55 patients with at least 24 months of recurrence-free follow-up. Preoperative standing lateral radiographs were used to measure lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI–LL mismatch. Intergroup comparisons were performed, followed by univariate logistic regression to identify independent associations. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate diagnostic performance. The RLDH group showed significantly lower LL (38° vs. 53°, p < 0.001) and greater PI–LL mismatch (9° vs. −3°, p < 0.001) compared with controls. No significant differences were found in PI, PT, or SS. Logistic regression identified LL (odds ratio [OR], 0.91; 95% CI, 0.87–0.94; p < 0.001) and PI–LL mismatch (OR, 1.09; 95% CI, 1.05–1.13; p < 0.001) as independently associated with recurrence. ROC analysis demonstrated good predictive ability for LL (AUC, 0.815; cutoff ≤49°) and PI–LL mismatch (AUC, 0.786; cutoff ≥4°). Reduced lumbar lordosis and increased PI–LL mismatch are independently associated with RLDH and demonstrate potential predictive value for recurrence risk. These findings highlight the importance of sagittal alignment in recurrence risk assessment and support their use in preoperative planning and surgical decision-making.