The correlation of clinical status and imaging findings in patients with chronic low back pain
Clinical and imaging findings in low back pain
Keywords:Low back pain, Lumbar lordosis, Lumbar spondylosis, Obesity
Background/Aim: Chronic low back pain (LBP) is a common health problem that negatively affects quality of life. A multidisciplinary approach is recommended in treating chronic LBP. In the literature, we could not find any study examining the relationship between clinical status, activities of daily living, angular measurements in the lumbar region, and spondylosis level in patients with LBP. We aimed to reveal whether there is a relationship between the severity of the clinical condition and these angular measurements. In addition, there are opposing views in the literature about the relationship between obesity and LBP, and we planned to investigate this issue in our study. We aimed to investigate the correlation between clinical, functional evaluations, and radiographic findings in patients with chronic LBP and examine the relationship between these variables and gender and educational level. We also determine the effects of age, body mass index (BMI), and waist circumference on these variables.
Methods: The research was designed as a cross-sectional, uncontrolled study. Seventy patients aged 18–65 years with chronic LBP and VAS (Visual Analog Scale) values ≥ 3 were included. Patients were grouped by gender and educational level. Lumbar lordosis angle (LLA), sacral inclination angle (SIA), and Kellgren-Lawrence (K-L) grade were recorded. VAS, Oswestry Disability Index (ODI), Back Pain Functional Scale (BPFS), and Katz Activities of Daily Living (Katz-ADL) scores were calculated. Pearson correlation analysis determined the normal distribution status of the variables. Spearman’s correlation analysis evaluated the linear relationship between ODI and BPFS and LLA and SIA continuous variables. A p-value of < 0.05 was considered statistically significant.
Results: A total of 70 patients (47 females and 23 males) with chronic LBP were included in the study. Mean BMI (28.2 [6.1] kg/m2) and waist circumference (95.7 [12.7] cm) of the patients were above normal ranges (normal BMI: 18.5–24.99 kg/m², normal waist circumference: < 80 cm for women, < 90 cm for men). Katz-ADL (P = 0.006) and BPFS scores (P = 0.027) were lower, and LLA (P = 0.042) was higher in women than men. The BPFS score was lower in the low-level education group than in the high-level education group (P = 0.004). There was a positive correlation between age and SIA (P = 0.028, r = 0.262), and between age and K-L grade (P < 0.001, r = 0.633). A positive correlation was also observed between BMI and K-L grade (P = 0.001, r = 0.395) and waist circumference and K-L grade (P < 0.001, r = 0.442).
Conclusion: No correlation was found between functional clinical scales and radiographic findings in patients with chronic LBP. Increasing age, BMI, and waist circumference were associated with more severe radiographic osteoarthritis of the lumbar spine, whereas female gender and low educational level were related to lower functional levels. Further extensive studies, including a larger number of patients, are needed to clarify our results.
Krismer M, van Tulder M, Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol [Internet]. 2007 Feb;21(1):77–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17350545 DOI: https://doi.org/10.1016/j.berh.2006.08.004
Sarıkaya S, Ozdolap S, Gumustas S, Koc U. Low back pain and lumbar angles in Turkish coal miners. Am J Ind Med 2007;50:92-6. DOI: https://doi.org/10.1002/ajim.20417
Nakipoğlu güldal funda, Karagöz A, Özgirgin N. the biomechanics of the lumbosacral region ın acute and chronic low back pain patients. painphysician. 2008;11(4):505–11. DOI: https://doi.org/10.36076/ppj.2008/11/505
Winnard A, Debuse D, Wilkinson M, Tahmosybayat R, Caplan N. The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain. Musculoskelet Sci Pract [Internet]. 2017 Jul;27 Suppl 1(7):S47–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28173931 DOI: https://doi.org/10.1016/j.msksp.2016.11.011
Choi S-A, Cynn H-S, Yi C-H, Kwon O-Y, Yoon T-L, Choi W-J, et al. Isometric hip abduction using a Thera-Band alters gluteus maximus muscle activity and the anterior pelvic tilt angle during bridging exercise. J Electromyogr Kinesiol [Internet]. 2015 Apr;25(2):310–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25262160 DOI: https://doi.org/10.1016/j.jelekin.2014.09.005
Amonoo-Kuofi HS. Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging. Acta Anat 1992;145:373-7. DOI: https://doi.org/10.1159/000147392
Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D et al.Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine 2004;29(5):581-5. DOI: https://doi.org/10.1097/01.BRS.0000113869.13209.03
Koç M, Bayar K. Turkish version of the Back Pain Functional Scale: validity and reliability study. J Exerc Ther Rehabil. 4(2):82-9.
Pehlivanoğlu Özkan EF, Özkan MU, Balcıoğlu H, Bilge U, Ünlüoğlu İ. Adjustment and Reliability of Katz Daily Life Activity Measures for Elderly in Turkish. Ankara Med J. 2018;(2):219-23. doi: 1017098/amj.435264.
Onyemaechi NO, Anyanwu GE, Obikili EN, Onwuasoigwe O, Nwankwo OE. Impact of overweight and obesity on the musculoskeletal system using lumbosacral angles. Patient Prefer Adherence [Internet]. 2016;10:291–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27022251 DOI: https://doi.org/10.2147/PPA.S90967
Ashraf A, Farahangiz S, Pakniat Jahromi B, Setayeshpour N, Naseri M. Correlation between Degree of Radiologic Signs of Osteoarthritis and Functional Status in Patients with Chronic Mechanical Low Back Pain. Malays J Med Sci [Internet]. 2014 Mar;21(2):28–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24876804
Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioral Sciences. 5th ed. Boston: Houghton Mifflin; 2003.
Unde Ayvat P, Aydın ON, Oğurlu M. [Risk factors associated with lower back pain in the Polyclinic of Algology]. Agri [Internet]. 2012;24(4):165–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23364779 DOI: https://doi.org/10.5505/agri.2012.38258
Turkish Endocrinology and Metabolism Association, Obesity Diagnosis and Treatment Guideline 2019, [Online]. Available: https://temd.org.tr/admin/uploads/tbl_kilavuz/20190506163904-2019tbl_kilavuz5ccdcb9e5d.pdf
Ibrahimi-Kaçuri D, Murtezani A, Rrecaj S, Martinaj M, Haxhiu B. Low back pain and obesity. Med Arch (Sarajevo, Bosnia Herzegovina) [Internet]. 2015 Apr;69(2):114–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26005262 DOI: https://doi.org/10.5455/medarh.2015.69.114-116
Chowdhury D, Sarkar S, Rashid MH, Rahaman A, Sarkar SK, Roy R. Influence of body mass index on low back pain. Mymensingh Med J [Internet]. 2014 Jan;23(1):125–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24584385
Murray KJ, Le Grande MR, Ortega de Mues A, Azari MF. Characterisation of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study. BMC Musculoskelet Disord [Internet]. 2017 Aug 1;18(1):330. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28764702. DOI: https://doi.org/10.1186/s12891-017-1696-9
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