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Shimokawa Tetsuya,Miyamoto Kei,Hioki Akira,Masuda Takahiro,Fushimi Kazunari,Ogawa Hiroyasu,Ohnishi Kazuichiro,Akiyama Haruhiko 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2
Study Design: Cross-sectional observational study. Purpose: To examine whether pelvic rotation as a compensatory mechanism for sagittal imbalance is related to quality of life (QOL). Overview of Literature: Poor sagittal alignment is associated with compensatory pelvic retroversion and decreased QOL. Whether the compensatory pelvic tilt (PT) influences QOL is unclear. Methods: Overall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups. Results: As SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p<0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p<0.05 for every comparison). Conclusions: This study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA.