Adiposity, lumbosacral lordosis and systemic inflammation in chronic low back pain: An analytical cross-sectional study

Abstract

Background and Aim: Chronic low back pain (cLBP) reflects spinal mechanics and low-grade inflammation, yet most studies treat body mass index (BMI) only as a baseline descriptor. To our knowledge, few studies have examined adiposity, lumbosacral alignment, inflammatory markers, pain intensity and disability side by side in a single cLBP cohort, which is the gap the present analysis sets out to fill. Methods: Forty-two adults with non-specific mechanical cLBP were assessed in one visit. BMI was recorded and the lumbosacral lordotic angle (LLA) measured on sagittal T2 MRI by the Cobb method. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and erythrocyte sedimentation rate (ESR) came from one venous sample. Pain used the Numerical Pain Rating Scale (NPRS) and disability the Indonesian Oswestry Disability Index (ODI). Spearman correlation was primary (Pearson reported alongside); subgroups (BMI <25 vs ≥25; men vs women) were compared with Mann-Whitney U. Results: Mean BMI was 25.2 kg/m²; 47.6% overweight or obese. BMI correlated positively with disability (Spearman r=0.37, p=0.016). A modest association with ESR appeared only in the Pearson analysis (r= 0.38, p=0.012) and did not hold under the primary Spearman test (r=0.21, p=0.183). Pain and LLA links were positive but non-significant; NLR and MLR were unrelated to BMI. Above BMI 25, median ODI, NPRS and ESR were higher but non-significant. ESR was far higher in women than men (median 17 vs 8 mm/h; p=0.002). Conclusion: Higher BMI tracked with greater disability, whereas its link with ESR was inconsistent across statistical methods and should be read as tentative; the inflammatory ratios were unmoved. Adiposity is an inexpensive, modifiable correlate alongside spinal alignment, not a replacement; ESR should be interpreted by sex. The modest sample (n=42) may have limited the power to detect the weaker associations; longitudinal work is needed before clinical use.

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