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Preoperative Spinopelvic Alignment in Recurrent versus Nonrecurrent Lumbar Disc Herniation: A Comparative Cohort
Utkan Topcu1, Zühtü Ozbek2, Emre Ozkara2
1Department of Neurosurgery, Acıbadem Hospital, Nilufer, Bursa, Türkiye.
World Neurosurgery
|April 23, 2026
Summary
Reduced lumbar lordosis and increased pelvic incidence-lumbar lordosis mismatch are key predictors of recurrent lumbar disc herniation after surgery. These spinopelvic alignment parameters can help assess recurrence risk and guide surgical planning.
Area of Science:
- Spine surgery
- Orthopedics
- Radiology
Background:
- Recurrent lumbar disc herniation (RLDH) poses a significant challenge after lumbar discectomy.
- Preoperative spinopelvic alignment may influence surgical outcomes and recurrence rates.
Purpose of the Study:
- To evaluate the association between preoperative spinopelvic alignment parameters and RLDH.
- To assess the predictive value of these parameters for RLDH following surgery.
Main Methods:
- Retrospective analysis of 117 patients undergoing single-level lumbar discectomy.
- Measurement of preoperative spinopelvic parameters including lumbar lordosis (LL) and pelvic incidence-lumbar lordosis (PI-LL) mismatch from lateral radiographs.
- Comparison between RLDH and control groups using logistic regression and ROC curve analysis.
Main Results:
- Patients with RLDH exhibited significantly lower LL and greater PI-LL mismatch compared to controls.
- LL (OR, 0.91) and PI-LL mismatch (OR, 1.09) were independently associated with RLDH.
- ROC analysis showed good predictive ability for LL (AUC, 0.815) and PI-LL mismatch (AUC, 0.786).
Conclusions:
- Reduced LL and increased PI-LL mismatch are significant independent predictors of RLDH.
- These sagittal alignment parameters offer potential for preoperative risk stratification.
- Findings support incorporating spinopelvic alignment assessment into surgical planning for lumbar disc herniation.
