Correlative Analysis of Lateral Vertebral Radiographic Variables and Medical Outcomes Study Short-Form Health Survey

Abstract

This prospective comparative study was designed to investigate the possible link between SF-36 functional status and lateral roentgenographic variables of the standing lumbar spine in patients with low back pain (LBP) versus asymptomatic volunteers. To the authors' knowledge, no previous studies have correlated SF-36 scores and sagittal roentgenographic variables in patients with LBP versus asymptomatic individuals. A total of 100 male volunteers, used as controls, and an equal number of age-, height-, and weight-comparable patients of the same ethnicity with chronic LBP were compared on the basis of roentgenographic and SF-36 data. The roentgenographic variables that were measured included the following: lumbar lordosis, sacral inclination, L1-S1 vertebral inclination, L4-S1 distal lordosis, disc index, and L1-L5 vertebral index. These variables were correlated with the eight SF-36 scales both in patients and controls. As the patients with LBP get older, they show lower functional scores in Role-Emotional (p < 0.01) and Physical Functioning (p < 0.01). Body height was not found to be a predisposition favoring LBP, but tall patients with LBP showed less Bodily Pain than patients of short stature (p < 0.001). This study showed that patients with LBP had significantly lower scores than their asymptomatic counterparts in the following SF-36 scales: Role-Physical (p < 0.01), Bodily Pain (p < 0.01), Role-Emotional (p = 0.058), and Mental Health (p < 0.001). In the controls General Health, Physical Functioning, Social Functioning, and Role-Emotional, Bodily Pain, Mental Health, and Vitality correlated statistically significantly with individuals' age, height, weight, lumbar lordosis, sacral inclination, inclination of L1, L3, and L5 vertebra, L1-L5 vertebral index, and L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 disc index. For the patients with LBP this study showed that General health, Physical Functioning, Role-Emotional, Social Functioning, and Bodily Pain were significantly correlated with age, height, L1-L2 inclination, distal lordosis, L2-L5 index, and L4-L5 and L5-S1 disc index. This comparative study showed that the functional status of hard-working patients with chronic LBP is associated with degenerative changes on the lateral radiographs of the lumbosacral spine. Spine surgeons should take into consideration the results of this study in reconstruction of painful degenerative lumbosacral spine.

Compensatory mechanisms contributing to keep the sagittal balance of the spine

“…PT, and that SS cannot be a negative number, you can tilt more with a high PI than with a low PI, since there is a much wider range through which adaptation can occur. Numerous studies reported that patients with chronic low back pain and lumbar degenerative disease were characterized by decrease of sacral slope and increase of pelvis tilt [2,8,12] as demonstrated in our illustrated case in Fig. 4.…”

“…5). Previous studies demonstrated that low back pain subjects were characterized by less distal lordosis, a more vertical sacrum and more proximal lumbar lordosis [8,12]. More proximal lumbar lordosis signified more extension in the upper lumbar spine.…”

Sagittal spino-pelvic alignment in chronic low back pain

“…Previous studies have also assessed spino-pelvic alignment in LBP and lumbar disk disease [7][8][9][10][11][12][13][14][15][16][17], but the relationship between sagittal alignment and LBP is still poorly understood. The current paper helps to better understand the relationship between sagittal alignment and LBP because it involves the largest database published so far in the literature on the evaluation of sagittal spino-pelvic alignment in chronic LBP.…”

“…Rajnics et al [11] also observed significant differences for SS, PT, and LLbut not PI nor TK-in 50 patients presenting with low back pain and disk herniation compared to 30 healthy subjects. Other studies also reported conflicting results suggesting either decreased [12], increased [13], or normal [14][15][16][17] LL in patients with LBP.…”

Correlation between symptoms and sagittal alignment parameters in patients with lumbar canal stenosis: a case-control study

“…Recent studies support the concept that the analysis of sagittal alignment of the spine is of fundamental importance in the diagnosis and therapy of degenerative diseases of the lumbar spine, especially when there is indication for surgical treatment, with instrumentation and fusion procedures included [1][2][3][4][5][6][7] . Several studies demonstrate the relationship between measurements of spinal and pelvic alignment in groups of normal subjects [8][9][10][11] and in groups of patients with lumbar degenerative disease 5,12 , with statistically significant results, but still not clinically significant i.e., with heterogeneous clinical presentations [13][14][15] .…”