Introduction
Spinopelvic alignment in sagittal plane is known be related to low back pain (LBP). Additionally, leg length discrepancy and abnormal foot arch have been proposed as possible risk factors for LBP. However, there is lack of the previous studies about the relationship between sagittal balance and lower extremities alignment measured in plain X-ray. This study aims to analyze an association between sagittal spinopelvic parameters and lower extremities radiologic alignments in for patients with LBP.
Methods
Medical records of patients with LBP between August 2014 and June 2019 were reviewed. Patients who had undergone back or leg surgery were excluded. Their standing X-rays in barefeet such as lateral view of whole spine with hip joints, orthoradiograms of whole lower extremities, and lateral view of both feet were assessed.
The radiographic parameters examined were thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sacrofemoral distance (SFD), sagittal vertical axis (SVA), spinosacral angle (SSA), C7 plumbline/sacrofemoral distance ratio (C7PL/SFD), quadriceps angle (Q-angle), leg length discrepancy (LLD) and calcaneal inclination (CI) (Figure).
All measurements were performed using Picture Archiving Communication System (PACS, M-view; Marosis, Seoul, Korea) software. Spearman’s correlation test was used on all parameters. Statistical analysis was performed using SPSS version 21 (SPSS Inc., Chicago, IL, USA).
Results
A total of 15 patients with chronic low back pain were enrolled for this study. Table summarizes correlations between all parameters. As in the previous studies, the correlation between TK and LL was significant. All of the sagittal spinopelvic parameters had no significant correlation with Q-angle and LLD. However, CI measured in lateral view of both feet showed a significant negative correlation with PI and SFD.
Conclusion
Sagittal spinopelvic parameters did not correlate with Q-angle and LLD, but showed a significant correlation with CI. These findings suggest that the evaluation of foot longitudinal arch alignment deformity is necessary as well as sagittal balance in patients with chronic LBP. Further study with larger sample size will be required to find more reliable results. |
