Sagittal spinopelvic parameters in lower extremity amputees with and without low back pain

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BACKGROUND: Lower limb amputees often experience low back pain (LBP), potentially due to altered spinal alignment and biomechanical challenges from prosthetic use. However, limited data exist on the role of spinopelvic parameters in this population. OBJECTIVE: To examine the relationship between sagittal spinopelvic alignment and LBP in individuals with unilateral lower extremity amputation. METHODS: This cross-sectional study was conducted in an inpatient rehabilitation unit of a tertiary university hospital. Thirty male participants aged 18-60 years with unilateral traumatic lower limb amputation were enrolled. They were divided into 2 groups: Group 1 (n = 13) without LBP and Group 2 (n = 17) with LBP. Pain was assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index. Radiographic evaluation included cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and spinal vertical axis (SVA). Quality of life was assessed using the SF-36. RESULTS: Significant differences were found in cervical lordosis (P=0.045, 95% confidence interval [CI], 0.17-14.36), thoracic kyphosis (P = 0.009, 95% CI -19.23 to -2.98), and SVA (P = 0.003, 95% CI, 0.11-0.54) between groups. Lumbar lordosis showed a negative correlation with VAS-pain scores (P = 0.031, r = -0.395), while thoracic kyphosis (P = 0.009, r = 0.466) and SVA (P = 0.001, r = -0.561) had positive correlations. Amputees with LBP had lower SF-36 scores in emotional well-being (P = 0.041), pain (P = 0.001), and general health (P=0.014) domains. CONCLUSIONS: Spinopelvic misalignment is associated with LBP in lower limb amputees. Rehabilitation strategies aiming to improve sagittal balance may reduce pain and enhance quality of life in this population.

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