Exploring the relationship between imaging features of lumbosacral structure and non-specific low back pain based on the theory of tendon off-position and mild malposition of bone and joint
Objective:To explore the relationship between imaging features of lumbosacral structure and non-specific low back pain(NSLBP)based on the theory of tendon off-position and mild malposition of bone and joint.Methods:Sixty NSLBP patients(LBP group)and 43 healthy volunteers(non-LBP group)were enrolled in the study,and their anteroposterior and lateral X-ray and CT films of lumbar spine were taken.The lumbosacral angle,coronal distance between transverse process and sacrum,and coronal distance between transverse process and ilium were measured on the anteroposterior and lateral X-ray films of lumbar spine,and the cross-sectional distance between transverse process and ilium was measured on the transverse CT films of lumbar spine.The relative values(ratio of difference between right distance and left distance to the right distance)of coronal distance between transverse process and sacrum,coronal distance between trans-verse process and ilium,and cross-sectional distance between transverse process and ilium were calculated,respectively;besides,the parallel tangent method was employed to determine whether the L5 vertebra was rotated on the transverse CT films of lumbar spine.The lumbosacral angle,incidence of rotation in L5 vertebra,and the relative values of coronal distance between transverse process and sacrum,coronal distance between transverse process and ilium,and cross-sectional distance between transverse process and ilium were compared between the two groups.The relative values of above-mentioned indicators of＜-5％,＞5％,and between-5％and 5％were defined as left-sided elongation,right-sided elongation,and bilateral symmetry,respectively.The patients with LBP were classified into 3 subgroups based on left-side pain,right-side pain,and bilateral pain,and the symmetry of imaging indicators in the lumbosacral region was compared among the dif-ferent subgroups.Results:The lumbosacral angle was smaller(t=2.458,P=0.016),the relative values of coronal distance between trans-verse process and ilium was larger(Z=-2.288,P=0.022),and the incidence of rotation in L5 vertebra was higher(x2=5.589,P=0.018)in patients with LBP compared to the ones without LBP;while the comparison of the relative values of coronal distance between transverse process and sacrum and cross-sectional distance between transverse process and ilium between the 2 groups revealed no signifi-cant differences(Z=-1.508,P=0.132;Z=-1.817,P=0.069).The differences were statistically significant among the 3 subgroups in symmetry of cross-sectional distance between transverse process and ilium(x2=9.309,P=0.011),while,were not statistically significant in the symmetry of coronal distance between transverse process and sacrum and the symmetry of coronal distance between transverse process and ilium(x2=0.512,P=0.473;x2=5.367,P=0.372).Conclusion:A decrease in lumbosacral angle,rotation in L5 vertebra,and an in-crease in relative values of coronal distance between transverse process and ilium are associated with NSLBP,and the symmetry of cross-sec-tional distance between transverse process and ilium is related to the side of LBP.The imaging features may serve as the radiological evi-dence of tendon off-position and mild malposition of bone and joint in the lumbosacral region of patients with NSLBP.
low back painlumbosacral regiontendon off-positionmild malposition of bone and jointimaging featuresradiographytomo-graphy,X-ray computed
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