Study on the correlation between sagittal parameters of spine and pelvis and the degree of low back and leg pain in elderly patients with lumbar disc herniation

WANG Qing-hai; SU Ke; SANG Wei-hua

doi:10.3969/j.issn.2095-252X.2025.07.009

Abstract：Objective To explore the correlation between sagittal parameters of spine and pelvis and the degree of low back and leg pain in elderly patients with lumbar disc herniation(LDH),and to analyze the predictive value of sagittal parameters of spine and pelvis for low back and leg pain in elderly patients with LDH.Methods The study subjects included 170 elderly patients with LDH who were diagnosed and treated in the Department of Orthopedics of Shenzhen TCM Hospital From October 2018 to October 2024.They were divided into non-pain group(n=56)and pain group(n=114)according to whether they had low back and leg pain;and divided into non-pain group(n=56),mild pain group(n=36),moderate pain group(n=53)and severe pain group(n=25)according to the degree of low back and leg pain.A retrospective analysis was used to collect the general data of the subjects,Japanese Orthopaedic Association(JOA)score,Oswestry Disability Index(ODI)and spinal-pelvic sagittal parameters,including sagittal vertical axis(SVA),thoracic kyphosis(TK),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),etc.The Pearson correlation analysis was used to explore the correlation between spinal-pelvic sagittal parameters and visual analogue score(VAS),JOA score and ODI.The influencing factors of low back and leg pain in elderly LDH patients were analyzed by logistic regression model,and the receiver operating characteristic curve(ROC)was used to evaluate the accuracy of the model.Results Compared with the non-pain group,the SVA,SS and PT values of the pain group were greater than those of the non-pain group(P<0.001);the TK,PI and LL of the pain group were less than those of the non-pain group(P<0.001).The results of variance analysis showed that the more severe the pain of the patient,the greater the corresponding SVA,SS and PT values(P<0.05),and the smaller the corresponding TK,PI and LL values(P<0.05).The proportion of patients with grade 2 or 3 lumbar disc herniation in the pain group was higher than that in the non-pain group(P<0.05),the ODI score was greater than that in the non-pain group(P<0.05),and the JOA score was less than that in the non-pain group(P<0.05).Pearson correlation analysis showed that there was no significant correlation between SVA and PI values and VAS scores in LDH patients(P>0.05),PT values were strongly positively correlated with VAS scores(P<0.001),TK values were weakly negatively correlated with VAS scores(P<0.001),LL values were strongly negatively correlated with VAS scores(P<0.001),and SS value was weakly positively correlated with VAS score(P<0.001);TK value and PT value of LDH patients had no significant correlation with JOA score(P>0.05),PI value and LL value were strongly positively correlated with JOA score(P<0.001;P<0.001),SVA value was weakly negatively correlated with JOA score(P=0.013),SS value was strongly negatively correlated with JOA score(P<0.001);PI and PT values of LDH patients had no significant correlation with ODI scores(P>0.05),SVA value was strongly positively correlated with ODI scores(P<0.001);TK and SS values were weakly positively correlated with ODI scores(P=0.010;P<0.001),and LL value was weakly negatively correlated with ODI scores(P=0.018).logistic regression analysis showed that TK,PT,SS and LL were independent risk factors for lumbar and leg pain in elderly patients with LDH(P<0.05),and the area under the ROC curve(AUC)of the model was 0.987,with good predictive efficiency.Conclusions The sagittal parameters of the spine and pelvis are closely related to the severity of lumbar and leg pain in the elderly.TK,PT,SS and LL are independent risk factors for lumbar and leg pain in elderly patients with LDH.