Spinal alignment and mobility in subjects with chronic low back pain with walking disturbance: a community-dwelling...

Chronic low back pain (LBP) is influenced by numerous factors and often shows a decline in walking abilities. However, the impact of spinal alignment and mobility on this condition and walking disturbance in the general population is unclear. A total of 672 community-dwelling individuals aged 20-94 years (mean, 69 years) in Kamikoani, Akita, Japan were divided into four groups: controls, subjects with no history of LBP (n = 121); HLBP group, subjects with a history of LBP (n = 323); CLBP group, subjects with chronic LBP without walking disturbance (n = 89); and CLBP-WD group, subjects with chronic LBP with walking disturbance (n = 139). Differences among groups were investigated in terms of angle of kyphosis, mobility, and inclination of the spine in upright, flexed, and extended positions, all measured using a computer-assisted device. HLBP, CLBP, and CLBP-WD groups showed significantly limited lumbar extension compared to controls (P < 0.05). The CLBP-WD group showed significantly increased thoracic and lumbar kyphosis angles and spinal inclination compared to the other groups (P < 0.05). Among subjects with chronic LBP (CLBP and CLBP-WD groups), associations between walking disturbance and measured variables were examined using logistic regression. According to multivariate analysis, lumbar kyphosis angle in upright position and spinal inclination in extended position were identified as indices associated with the presence of walking disturbance in subjects with chronic LBP. These results indicate that increased lumbar kyphosis and limitation of total spinal extension are important risk factors for walking disturbance in subjects with chronic LBP.