Objective <p>This study aimed to identify clinical and imaging risk factors for lumbar disc prolapse (LDP) by integrating demographic variables, lifestyle-related factors, imaging biomarkers, and binary logistic regression.</p> Methods <p>Patients with lumbar disc herniation admitted to the Department of Spine Surgery, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from May 2024 to October 2025 were enrolled and categorized into LDP and non-LDP groups according to CT/MRI findings. Binary logistic regression was used to identify factors associated with LDP.</p> Results <p>Significant differences were observed between the two groups in gender, occupation type, affected spinal segment, intervertebral disc space height, spinal canal area, and nucleus pulposus occupancy rate (NPOR) (<i>P</i> &lt; 0.05). Multivariate logistic regression identified male gender, sedentary occupation, reduced disc space height, and higher NPOR as independent factors associated with LDP (<i>P</i> &lt; 0.05).</p> Conclusion <p>LDP is associated with multiple clinical and imaging factors. Male gender, sedentary occupation, reduced intervertebral disc space height, and higher NPOR were the key factors associated with the occurrence of LDP. NPOR may serve as a practical, non-invasive quantitative imaging biomarker derived from routine lumbar CT/MRI for assessing canal occupation in patients with lumbar disc herniation, although its causal significance and prognostic thresholds require prospective validation.</p> Trial registration <p>Not applicable. This is a retrospective observational study.</p>