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Background: Sagittal balance depends on the interaction between lumbar alignment and spinopelvic parameters such as lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). Although these parameters are well described in deformity surgery, their early and mid-term postoperative behavior in lumbar disc herniation (LDH) is not clearly defined. This study evaluated temporal changes in LL, PT, SS, and PI after single-level microdiscectomy at postoperative day 15 and at 1, 3, and 6 months. Methods: This retrospective study included patients who underwent single-level microdiscectomy (L4-L5 or L5-S1) for radiologically confirmed LDH between 2019 and 2021. Standardized standing lateral radiographs were obtained preoperatively and at each postoperative visit. LL, PT, SS, and PI were independently measured by two radiologists (interobserver reliability ICC > 0.90). Pain severity was assessed using the Visual Analog Scale (VAS). Temporal changes were analyzed using paired comparisons with 95% confidence intervals. Results: PT, PI, and SS demonstrated significant early reductions that continued throughout follow-up (p < 0.05). LL increased gradually and reached significance at 6 months (p < 0.001). VAS scores decreased markedly at all postoperative time points (p < 0.001), indicating substantial and sustained pain improvement. Conclusion: In patients with clinically successful microdiscectomy, PT, SS, and PI showed early postoperative changes consistent with normalization of pain-related posture rather than true structural modification. LL showed a delayed but statistically significant increase by 6 months, which may be related to gradual recovery of muscular and postural function. These findings outline typical radiographic evolution after microdiscectomy and may help clinicians distinguish expected postoperative alignment changes from pathological deviations.
Dağıstan et al. (Mon,) studied this question.