腰痛与腰骶移行椎患者的脊柱骨盆参数的相关性及影响因素/预测模型分析

Risk stratification and predictive modeling of spinopelvic disorders in LSTV-associated low back pain

  • 摘要: 背景 矢状位失衡是下腰痛(low back pain,LBP)的重要致病机制, 腰骶移行椎(lumbarsarcal transitional vertebrae,LSTV)患者会由于脊柱失衡导致其脊柱骨盆参数改变,这与下腰痛发病率增高是否具有相关性仍缺乏充分证据。目的 探讨LSTV患者脊柱矢状位平衡的改变引起的脊柱-骨盆矢状面参数差异,并分析其与LBP的关系。方法 回顾性分析2023 年1 月至2024 年1 月就诊于解放军总医院第一医学中心骨科门诊以健康体检为主诉进行脊柱检查的患者。依据Castellvi 分型标准进行分为正常对照组和不同亚型腰骶移行椎组,比较组间下腰痛患病率、Oswestry 功能障碍指数(oswestry disability index,ODI)和骨盆矢状面参数的差异,并进行LBP 与脊柱骨盆矢状面参数相关检验及影响因素分析。结果 本研究共纳入971 例患者,其中LSTV 组204 例,正常健康组767 例。与正常健康组对比,LSTV 组LBP 患病率(57.8% vs 15.6%,P<0.001)和ODI 评分(15.32±8.45 vs 9.67±5.06,P<0.001)更高,且脊柱骨盆参数骨盆入射角(50.58±10.71 vs 49.18±7.12,P=0.027)和骨盆入射角-腰椎前凸角显著增高(-6.41±11.37 vs -8.69±10.76,P=0.008),提示其腰椎前凸不足以匹配骨盆形态,可能引起脊柱骨盆的矢状面失衡。Castellivi 分型Ⅱ、Ⅳ型患者ODI 评分与骨盆入射角(r=0.24,P=0.007)、腰椎前凸角(r=-0.28,P<0.001)和骨盆入射角-腰椎前凸角(r=0.37,P<0.001)具有显著相关性。多元logistic 回归显示,参照健康对照组,身体质量指数(body mass index,BMI)大于28(OR=2.592,95% CI:1.190 ~ 5.641),腰骶移行椎(OR=7.060,95% CI:2.488 ~ 20.020),体力劳动为主的职业(OR=1.659,95% CI:1.030 ~ 2.671)为影响患者健康状况的独立危险因素。以回归风险构建的下腰痛预测评估模型,其ROC-AUC为0.706(95% CI:0.664 ~ 0.747)。结论 LSTV尤其Castellivi Ⅱ/Ⅳ型患者的脊柱局部矢状位稳定性受到显著影响,其脊柱-骨盆矢状面参数发生改变,这可能是导致下腰痛的重要原因。

     

    Abstract: Background Sagittal imbalance is an important pathogenic mechanism of low back pain in clinical practice. Patients with lumbosacral transitional vertebrae (LSTV) may experience altered spinopelvic parameters due to spinal imbalance. However, it remains unclear whether such changes correlate with increased incidence of low back pain.  Objective To investigate the prevalence and severity of low back pain in LSTV patients, identify differences in spinopelvic sagittal parameters affecting spinal sagittal balance among distinct LSTV subtypes, analyze key biomechanical mechanisms underlying low back pain from spinopelvic alignment perspectives, and establish an initial predictive model. Methods  A retrospective analysis was conducted on individuals who underwent spinal examinations during health checkups at the First Medical Center of PLA General Hospital from January 2023 to January 2024. Based on Castellvi classification criteria, participants were categorized into a normal control group and LSTV subgroups with different subtypes. Comparative analysis assessed intergroup differences in low back pain prevalence, Oswestry Disability Index (ODI) scores, and pelvic sagittal parameters, followed by correlation testing between back pain severity and spinopelvic alignment parameters with subsequent multivariate regression to identify contributing factors.Results The study cohort comprised 971 patients (204 LSTV cases vs 767 normal controls), revealing significantly higher low back pain prevalence (57.8% vs 15.6%, P<0.001), elevated ODI scores (15.32± 8.45 vs 9.67±5.06, P<0.001), and increased spinopelvic parameters in LSTV patients-specifically pelvic incidence (PI: 50.58±10.71 vs 49.18±7.12, P=0.027) and PI-lumbar lordosis mismatch (PI-LL: -6.41±11.37 vs -8.69±10.76, P=0.008) -suggesting inadequate lumbar curvature to accommodate pelvic morphology potentially drives sagittal imbalance. Notably, ODI scores in Castellvi types Ⅱ/ Ⅳ correlated significantly with PI (r=0.24, P=0.007), LL (r=-0.28, P<0.001), and PI-LL (r=0.37, P<0.001). Multivariate regression identified BMI ≥28 (OR=2.592, 95% CI: 1.190-5.641), LSTV diagnosis (OR=7.060, 95% CI: 2.488-20.020), and physically demanding occupations (OR=1.659, 95% CI: 1.030-2.671) as independent risk factors for impaired recovery (P<0.05), with the derived predictive model demonstrating moderate discrimination (ROC-AUC=0.7058; 95% CI: 0.6644-0.7473). Conclusion In patients with (LSTV, particularly those classified as Castellvi types Ⅱ and Ⅳ, significant impairment of local sagittal spinal stability occurs, accompanied by alterations in spinopelvic sagittal parameters-these biomechanical disturbances may constitute a significant contributor to the pathogenesis of low back pain.  Sagittal imbalance is an important pathogenic mechanism of low back pain in clinical practice. Patients with lumbosacral transitional vertebrae (LSTV) may experience altered spinopelvic parameters due to spinal imbalance. However, it remains unclear whether such changes correlate with increased incidence of low back pain.

     

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