Correlation between Radiographic Parameters and Lordosis in Patients with Chronic Low Back Pain

Low back pain (LBP) is a global health problem with a multifactorial etiology. Many clinicians believe that a change in the lumbar lordosis is a cause of LBP. The normal range of lordosis has not yet been agreed on. Consequently, the practice of measuring the lordosis needs to be re-evaluated. Our study aims primarily to determine the lumbar lordotic angle (LLA) and lumbosacral angle (LSA) in individuals with and without chronic LBP (CLBP), and secondarily to analyze the correlation between age, gender, body mass index (BMI), and pain severity.

In this prospective case-control research, 200 adults of both genders participated. The participants were split into two groups: The control group and the case group. One hundred individuals with persistent LBP were part of the case group. In addition, 100 subjects who were matched for age, gender, and BMI were included in the control group. Lateral projection radiographs in a standing position of the lumbar spine were taken for all the subjects. The lordosis angles (LLA and LSA) were recorded by a radiologist, who was blinded to the subjects' clinical findings.

There were 100 subjects each in the case group and the control group. Both groups were similar with respect to age (P = 0.407), gender (P = 0.315), and mean BMI (P = 0.239). The mean LSA was 34.17 ± 5.86 (M: 35.19 ± 6.86; F: 33.55 ± 5.07) in the cases group and 36.69 ± 6.72 (M: 37.68 ± 6.78; F: 35.87 ± 6.63) in the control group (P = 0.001). The mean LLA was 50.04 ± 9.09 (M: 53.99 ± 8.93; F: 48.25 ± 8.55) in cases and 49.60 ± 9.77 (M: 48.78 ± 9.69; F: 50.30 ± 9.88) in controls (P = 0.737). Subjects with CLBP show decreased LSA in 31-40 years of age (P = 0.013), in females (P = 0.02), and in overweight individuals (P = 0.002), and increased LLA in males (P = 0.001), but the difference in angles was only 2-4°. Neither LSA nor LLA shows any association or correlation with age, gender, BMI, or Visual Analog Scale (VAS).

The results have shown that LLA does not vary in those with and without nonspecific CLBP. LSA and LLA do not show a clear association and show an insignificant weak correlation with age, gender, BMI, and VAS in cases as well as controls.