Background Lumbar Intervertebral disc prolapse (IVDP) is a prevalent cause of low back pain and radicular symptoms, often associated with Sagittal Spinopelvic imbalance. The role of Sagittal imbalance as a risk factor for symptom recurrence in IVDP remains underexplored. This study aimed to evaluate the correlation between Sagittal Spinopelvic imbalance and symptom recurrence in patients with lumbar IVDP. Methods A prospective observational study was conducted from December 2016 to November 2017, enrolling 70 patients with lumbar IVDP. Patients underwent clinical assessment using the Oswestry Disability Index (ODI) and radiological evaluation with standing lateral X-rays to measure sagittal parameters: C7 plumb line (C7PL), thoracic Kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Sagittal imbalance was defined as C7PL > 5 cm or |PI - LL| > 10°. Follow-ups occurred at 1 week, 2 weeks, 1 month, 3 months, and 6 months, with recurrence defined as an increase in ODI scores after a pain-free period of at least 1 month. Data were analyzed using SPSS v21.0, with p < 0.05 considered significant. Results Of the 70 patients (mean age 48 ± 14.39 years; 57% female), 29 (41.4%) exhibited Sagittal imbalance. No significant correlation was found between C7PL and age (r = 0.251, p = 0.07) or gender (p = 0.454). Patients with Sagittal imbalance had significantly higher ODI scores at 6 months (mean ± SD: 14.97 ± 10.16 vs. 6.8 ± 6.72; p < 0.001). Symptom recurrence occurred in 25 patients (35.7%) and was strongly associated with Sagittal imbalance (p = 0.001), with 58.6% of imbalanced patients experiencing recurrence compared to 19.5% of balanced patients. Conclusion Sagittal Spinopelvic imbalance is a significant risk factor for symptom recurrence in lumbar IVDP. Routine radiological assessment of sagittal balance is recommended to identify high-risk patients and guide treatment strategies, including surgical planning for fusion procedures. This study is the first to establish this link, though further research is needed to validate findings.

Sagittal Spinopelvic Balance, Recurrence, Lumbar Intervertebral Disc Prolapse, Radiological Parameters.