Relationship of Sagittal Spinal Alignment With Low Back Pain And Physical Performance In A Population-Based Japanese Cohort: The Wakayama Spine Study

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Studies have suggested a relationship between sagittal malalignment of the spine and low back pain (LBP). The Wakayama Spine Study investigated the relationship between spinal alignment, LBP, and physical performance in 1491 individuals who attended a second follow-up visit as part of the ROAD Study and for whom standing lateral spinal radiographs were available. The sagittal vertical axis at C7 (C7 SVA) was measured by a spinal surgeon. LBP in the previous month was determined by the Oswestry Disability Index (ODI), and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and significantly greater in older subjects (p<0.001). Based on their C7 SVA, the subjects were divided into small (<40 mm), intermediate (40≤SVA<95 mm), and large (≥95 mm) groups. LBP was more prevalent in subjects with a larger C7 SVA (small, 35.7%; intermediate, 47.3%; large, 59.4%; p<0.001) and those with a higher ODI score (10.0%, 17.5%, and 29.4%, respectively; p<0.001). Physical performance was significantly decreased in subjects with a larger C7 SVA (p<0.001). Multiple linear regression analysis revealed that LBP and physical performance were significantly associated with C7 SVA (p<0.001). Thus, sagittal malalignment of the spine may lead to LBP and decreased physical performance.