Background: Lumbar intervertebral disc herniation (LDH) is a major contributor to low-back pain. It is unknown how cigarette smoking duration and occupation combine to increase LDH risk in Sudanese males. Objectives: Quantify MRI-confirmed LDH patterns in male smokers and determine if long-term smoking (>10 years) and manual employment independently predict pathology. Methods: A prospective cross-sectional study of 56 male smokers (mean age 46？ ± ？12？years). Smoking history, occupation, and MRI data were analyzed using χ2 tests. Variables with p？ < ？0.10 were incorporated into a multivariable logistic-regression model (backward likelihood-ratio) to yield adjusted odds ratios (AORs, 95？% confidence interval). The analyses were done using SPSS v29. Sample size justification: G*Power 3.1 shows that n = 56 has 80% power to detect an OR ≥ ？2.8 at α = ？0.05. Results: LDH was found to be independently predicted by smoking for more than 10 years and manual labor (AOR = 3.2, 95% CI = 1.4 - 7.1 and AOR = 2.7, 95% CI = 1.1 - 6.5, respectively; both p < 0.01). Longer smoking duration and occupational load increase LDH risk. Integrated smoking cessation and ergonomic programs may reduce this burden.
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