Pelvic incidence–lumbar lordosis mismatch in non-specific low back pain: Associations with pain, disability and lumbar structural findings — A retrospective cross-sectional study
Ertan Yilmaz, Kubra Ustaomer, Cihan Ozgur, Birol Topcu, Banu SarifakiogluBackground
Pelvic incidence–lumbar lordosis (PI–LL) mismatch is associated with adverse outcomes in spinal deformity, but its relevance in nonspecific low back pain (LBP) is unclear.
Objective
To assess whether PI–LL mismatch is associated with pain, disability, symptom duration and structural findings in nonspecific LBP.
Methods
In this retrospective cross-sectional study, consecutive patients aged 30–65 years with conservatively managed nonspecific LBP ≥4 weeks and lumbar magnetic resonance imaging plus standing lateral radiography from May 2022 to May 2023 were identified from hospital records and assessed at a single standardized visit between May 2023 and February 2024. Pelvic incidence and L1–S1 lordosis were measured; mismatch was defined as ≥10°. Pain (visual analogue scale, VAS), disability (Oswestry Disability Index, ODI), facet tropism (facet angle asymmetry >7°), and Goutallier-graded paraspinal fatty infiltration were assessed. Groups were compared with parametric and non-parametric tests and multivariable linear regression; the sample could detect d = 0.55 (80% power, α = 0.05).
Results
Of 105 patients, 51 had a mismatch. VAS, symptom duration and ODI were higher in the mismatch group. After adjustment, a mismatch remained independently associated with higher VAS and longer duration, but not with ODI. Facet tropism was more prevalent at L4–5 and L5–S1, and multifidus fatty infiltration was higher at L2–3.
Conclusion
In conservatively managed nonspecific LBP, PI–LL mismatch was independently associated with greater pain and longer symptom duration and co-occurred with segment-specific structural changes. Prospective studies are needed to establish its prognostic values.