Psychopathological profile and sagittal alignment in low-back pain

Introduction: Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a given psychopathological profile is little studied. The aim of this study was to analyze the psychopathological profiles and sagittal parameters of a population with low-back pain and to assess the link. Material and methods: 205 patients, with a mean age of 49.6 years (range, 18-70 years), presenting chronic common low-back pain without radicular involvement, were included prospectively. Mood scores comprised: the self-administered "Hospital Anxiety and Depression Scale" (HAD), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS). Radiological parameters, measured on lateral full-spine radiographs, included: L1-S1 lordosis, T1-T12 kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 slope, and Roussouly type. Results: Mean HAM-A score was 16.1; 54% of patients had scores >= 14, indicating anxiety disorder. Mean HAM-D score was 10.8; 55% of patients had scores >= 10, indicating depressive disorder. Mean YMRS score was 2.6; only 1 patient had a score >= 20, indicating manic disorder. The 112 patients with HAM-A score > 14 showed mean 51.6 degrees L1-S1 lordosis (p = 0.356), 48.3 degrees T1-T12 kyphosis (p = 0.590), -4.3 mm C7 SVA (p = 0.900), and 29.3 degrees T1 slope (p = 0.451). In case of HAM-A <14, there were no significant differences. The 113 patients with HAM-D score > 10 showed significant differences in T1-T12 kyphosis (mean 49.0 degrees; p < 0.05) and T1 slope (30.2 degrees; p < 0.05); mean L1-S1 lordosis was 50.5 degrees (p = 0.861) and C7 SVA 1.6 mm (p = 0.462). In case of HAM-D < 10, T1-T12 kyphosis was 45.5 degrees (p < 0.05) and T1 slope 26.2 degrees (p < 0.05); mean lordosis was 50.9 degrees (p = 0.861) and mean C7 SVA -7.1 mm (p = 0.259). Multivariate analysis found no significant link between Roussouly type and psychiatric scores: HAD (p = 0.715), HAM-A (p = 0.652), and HAM-D (p = 0.902). Conclusion: More than 50% of patients with common low-back pain presented a mood disorder. Depres-sive disorder was associated with greater T1-T12 kyphosis and T1 slope. There was no relationship between psychiatric scores and overall sagittal alignment.Level of evidence: II.(c) 2022 Published by Elsevier Masson SAS.