| BackgroundLow Back Pain(LBP)is a common orthopedic condition with lifetime prevalence up to 80%.Non-specific Low Back Pain(NLBP),with a 70% lifetime prevalence,occupies the highest prevalence rate among LBP.The recurrence rate of LBP within 1 year is up to 65%once LBP symptoms present.NLBP’s high recurrence rate is closely related to the exclusionary diagnostic criteria which left varieties of pathogenic mechanisms of it.As a result,the treatment of NLBP is rather a symptom-relief clinical-trails based on limited symptoms than a precise treatment.Consequently,NLBP resulted in high recurrence rate and symptom related sick leaves,which impose adverse effects on patients themselves and normal social work.Therefore,the diagnosis and treatment of NLBP has been a topic of general interest at home and abroad.The diagnosis of NLBP is the most important issues.In young male population of our country,NLBP accounts for 47.3% of all the causes of consultation.NLBP rate is rather higher in the special working population,accounting for about 70-90%,causing serious health problems.In recurrent NLBP patients,a significant proportion of them have been found with quite normal imaging,but their iliac crest line level in the standing position allocate above or below the L4/5 intervertebral space,indicating that such changes may relate to high recurrence rate of NLBP.If the location of iliac crest line can be proved as a indicator for NLBP,it will facilitate the discrimination of people who is vulnerable to NLBP,and thus reducing the incidence of NLBP.Part I.Comparison between the location of the iliac crest line in patients with non-specific low back pain and patients without low back painObject:To investigate the difference between non-specific low back pain patients and without low back pain.Methods:We retrospectively reviewed young male patients with chief complaint of "low back pain",who met the criteria for inclusion and exclusion from July 2021 to November 2021 in our hospital,and defined them as “NLBP group”.Also,“non-LBP” group were defined as patients without LBP during the same period,who met the criteria for inclusion and exclusion.Ages and the location of iliac crest line of both groups were recorded.According to the data characteristics,differences of ages and the location of iliac crest line between NLBP group and non-LBP group were analyzed by Mann-Whitney U test.Results.289 patients were enlisted into NLBP group,80 patients were enlisted into non-LBP group.The average age of NLBP group(22.86 ± 0.19 years)was significantly lower than that of non-LBP patients(26.76 ± 0.42 years);the location of iliac crest line in non-LBP group concentrated at the L4/5 intervertebral space(47.5% at L4/5),an approximately normal distribution(with kurtosis 0.018,skewness-0.008),whereas the iliac crest line in NLBP group deviated downwards the L4/5 intervertebral space(43.6% below L4/5),a positively skewed distribution(with kurtosis-0.596,skewness 0.15).It is suggested that the position of the iliac crest line at the L4/5 intervertebral level is related to the occurrence age of NLBP.Part II.Correlation analysis between the position of the iliac crest line and pelvic parameters in patients with nonspecific low back painObject:To evaluate the relationship between the location of iliac crest line and pelvic parameters/lumbar lordosis angle among non-specific low back pain patients.Methods.We retrospectively reviewed young male patients with chief complaint of "low back pain",who met the inclusion and exclusion criteria,from July 2021 to November 2021 in our hospital.Parameters including patient ages,location of iliac crest line,pelvic parameters and lumbar curvature were recorded.Patients were grouped base on different location of iliac crest line.According to data characteristics,difference of ages,pelvic parameters and lumbar lordosis between groups were analyzed by Mann-Whitney U test.Correlation and multivariate logistic regression analysis were used to analyze the relationship between iliac crest line and other parameters.Results.1,289 patients were enlisted.Patients were regrouped according to the location of the iliac crest line.There was no statistical difference in age between the groups(P=0.721).Statistical differences were found in PI,PT,SS,and LL(P<0.05,respectively),parameters were not completely equal between groups.2,Location of Iliac crest line has moderate positive correlation with SS(r=0.430),moderate negative correlation with PT(r=-0.412),weak correlation with LL(r=0.129),and has no correlation with PI(r=-0.071).3,The logistic regression model of the location of iliac crest line,SS,PT,and LL:G1: P(iliac crest line-2 group)/P(iliac crest line-0 group)=2.383-0.095SS-0.003PT-0.001 LL G2: P(iliac crest line-1 group)/P(iliac crest line-0 group)=12.157-0.232SS-0.102PT-0.117 LL G3: control group G4: P(iliac crest line +1 group)/P(iliac crest line 0 group)=1.077-0.034SS-0.134PT+0.026 LL G5: P(iliac crest line + 2 groups)/P(iliac crest line 0 groups)=0.008-0.047SS-0.091PT-0.025LLThe Logistic regression model indicates that SS and PT are pelvic parameters which influence the location of iliac crest line most.4,The smaller the SS is,and the larger the PT is,the more likely the iliac crest line locates below the L4/5 intervertebral space,presenting a posterior pelvic morphology;conversely,the larger the SS is,the smaller the PT is,the more likely the iliac crest line locates above the L4/5 intervertebral space,presenting an anterior pelvic morphology.Combined with previous research,this research suggests that the iliac crest line below L4/5level may be a risk factor for the prevalence of NLBP.Part III Clustering analysis study of the location of the iliac crest line and spine related parameters in patients with nonspecific low back painObject:To investigate the difference between iliac crest line position and spinal parameters in NLBP patients by systematic clustering analysis among non-specific low back pain patients.Methods.We retrospectively reviewed young male patients with chief complaint of "low back pain",who met the inclusion and exclusion criteria,from August 2021 to December 2021 in our hospital.The iliac crest line position,lumbar curvature,height and width vertebral body,height of intervertebral space,height and length of vertebral transverse process,sagittal articulation angle,height and width of spinous process,and spinous process spacing were measured in NLBP patients.By using systematic clustering method,patients were divided into groups.Mann-Whitney U test were used to compare intergroup difference.Clinical significance was explored based on the results of cluster analysis and intergroup difference.Results.1,178 patients enlisted.Cluster analysis classified patients into 5 groups which characterized by different levels of the iliac crest line.2,Even in the NLBP patients,the onset of NLBP was significantly earlier in patients whose iliac crest lines deviated from the L4/5 level than in those whose iliac crest lines were at the L4/5 level.Patients with the iliac crest line at the middle 1/3 of L5 level had lower vertebral body height,greater vertebral body width,smaller vertebral body ratio,and exhibited a flatter morphology;conversely,patients with the iliac crest line at the middle 1/3of L3/4 level had higher vertebral body height,narrower vertebral body width,greater vertebral body ratio,and exhibited a taller and leaner morphology.Conclusion.1.The age of onset of low back pain was significantly earlier in patients whose iliac crest lines locate below the L4/5 level than in patients whose iliac crest lines locate at the L4/5 level.It is suggested that whether the position of the iliac crest line is at the L4/5intervertebral space level is a risk factor for NLBP.2.The smaller the SS is and the larger the PT is,the more likely the iliac crest line will locate below the L4/5 intervertebral space,presenting a posterior pelvic pattern;conversely,the larger the SS is,and the smaller the PT is,the more likely the iliac crest line will locate above the L4/5 intervertebral space,presenting an anterior pelvic pattern.The iliac crest line below the level of L4/5 may be a risk factor for the prevalence of NLBP.3.Cluster analysis classify NLBP patients into five major groups,each group was characterized by different levels of the iliac crest line.Even in the NLBP population,the onset age of NLBP was significantly earlier in patients with an iliac crest line above the L4/5level than in patients with an iliac crest line at the L4/5 level.Patients with the iliac crest line at the L5 middle 1/3 level have lower vertebral body height,greater vertebral body width,smaller vertebral body ratio,and a flatter morphology;conversely,patients with the iliac crest line at the L4 middle 1/3 level have higher vertebral body height,narrower vertebral body width,greater vertebral body ratio,and a taller and thinner morphology.Therefore,those with the iliac crest line at the L4/5 intervertebral space have a better biomechanical status.The iliac crest line is higher than the L4/5 level may be a risk factor for the prevalence of NLBP.4.Combined with the recent research,whether the position of the iliac crest line at the level of the L4/5 intervertebral space may have potential to work as a risk factor for NLBP.The position of the iliac crest line at the L4/5 intervertebral space level may be a protective factor for NLBP in young adults,and the position of the iliac crest line above or below the L4/5 intervertebral space level may be a risk factor for NLBP in young adults.However,this study has limited subjects and limited follow up.Thus,whether the iliac crest line can be considered as a risk factor for NLBP still needs a long follow-up study with a large sample in the future. |
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