Is there a relationship between chronic low back pain and spinal sagittal balance? A prospective controlled study

Abstract

Aim: Evaluation of whether there is a significant relationship between chronic low back pain and spinal sagittal alignment. Methods: This prospective, controlled study was conducted between April 2023 and September 2023, among patients aged 18–50, who complained of chronic low back pain and a healthy control (HC) group. In addition to the participant's demographic information, sagittal vertical axis (SVA), thoracic kyphosis (TK), and lumbar lordosis (LL) values on the lateral whole-spine radiograph and degenerations on the lumbar vertebra MRI were compared. VAS and ODI scores of the patients were also included in the statistical evaluation. Results: A total of 64 participants (44 patients, 20 controls) were included in the study. There was no significant difference in age, gender, body mass index (BMI). SVA significantly increased in the patient group (p < 0.001), but not LL and TK. In a linear discriminant analysis (LDA), SVA discriminates 100% of the two groups. No significant correlation was observed between VAS and ODI scores and the patient's age, gender, BMI, and spinal parameters. Conclusion: SVA is a crucial parameter of spinal balance, and as shown in this study, deviations from normal SVA appear to be a significant contributor to low back pain. We recommend an easy-to-implement and cost-effective method for assessing SVA in evaluating and treating patients with chronic low back pain.