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Associations between potentially modifiable clinical factors and sagittal balance of the spine in older adults from the general population

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Abstract

Purpose

Spinal sagittal balance is associated with back pain and quality of life. Enhancing understanding of the clinical factors associated with sagittal balance is essential for guiding the development of effective non-operative treatment. We aimed to evaluate the associations between spinal sagittal balance and potentially modifiable clinical factors and interactions between current back pain and the evaluated clinical factors.

Methods

We conducted a cross-sectional study where sagittal alignment, measured radiographically by EOS, was defined by sagittal vertical axis (SVA). The clinical factors included non-radiographic (NR) lumbar lordosis angle, balance (Berg balance scale), hip and back extension range of motion (ROM) and extensor strength, and back pain. Pearson’s correlation coefficients and multivariable regression analyses were conducted in 63 adult participants (70% female, mean age 73 (SD 8.6) years) from the general population.

Results

We identified correlations between SVA and age (r = 0.4, p < 0.001), body mass index (BMI) (r = 0.3, p = 0.008), balance (r = − 0.5, p < 0.001) and NR lumbar lordosis angle (r = − 0.5, p < 0.001). The final model (R2 = 58%) identified that, after controlling for age and BMI, larger SVA was associated with lower NR lumbar lordosis (R2 = 15%, p < 0.001), poorer balance (R2 = 7%, p = 0.02), greater hip extensor strength (R2 = 4%, p = 0.053), and among people with back pain, NR lumbar extension ROM (R2 = 3%, p = 0.034). Hip ROM and lumbar strength were not significant.

Conclusion

Reduced NR lumbar lordosis magnitude and ROM, balance and hip strength are associated with SVA; however, it is unclear if these factors are compensatory, contributing, or modifiable. Hence, future longitudinal studies are needed.

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Acknowledgements

Prof Armando Teixeira-Pinto (Biostatistician) for assistance with statistics.

Funding

Apart from author MS, no authors received support from any organization for the submitted work. MS received support from the University of Sydney SOAR fellowship.

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, 2006, Australia

    Larry Cohen, Evangelos Pappas, Kathryn Refshauge, Sarah Dennis & Milena Simic

  2. The University of Wollongong, Wollongong, NSW, Australia

    Evangelos Pappas

  3. South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia

    Sarah Dennis

  4. Ingham Institute of Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia

    Sarah Dennis

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  1. Larry Cohen
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Contributions

Author LC was involved with the conception, data collection, data analysis and write up of the manuscript. Author SD was involved with the conception, data collection, data analysis and write up of the manuscript. Author MS was involved with the conception, data collection, data analysis and write up of the manuscript. Author EP was involved with the conception, data collection, data analysis and write up of the manuscript. Author KR was involved with the data collection, data analysis and write up of the manuscript. LC, EP, SD, MS: Substantial contributions to the conception or design of the work (or), LC, EP, KR, SD, MS: acquisition, analysis, or interpretation of data for the work (and), LC, EP, KR, SD, MS: Drafting the work or revising it critically for important intellectual content (and), LC, EP, KR, SD, MS: Final approval of the version to be published

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Correspondence to Larry Cohen.

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Author LC is a physiotherapist and has a financial interest at UprightCare clinic in Sydney Australia.

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Cohen, L., Pappas, E., Refshauge, K. et al. Associations between potentially modifiable clinical factors and sagittal balance of the spine in older adults from the general population. Spine Deform 10, 433–441 (2022). https://doi.org/10.1007/s43390-021-00435-y

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  • DOI: https://doi.org/10.1007/s43390-021-00435-y

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