{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:06:26Z","timestamp":1780596386268,"version":"3.54.1"},"reference-count":20,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Lumbar facet joints are a significant source of chronic low back pain (CLBP), and medial branch blocks (MBBs) are the widely accepted reference diagnostic approach for diagnosis. However, clinical response varies. This study aims to investigate whether sagittal spinopelvic alignment parameters can predict the clinical efficacy of MBB in patients with facet-mediated CLBP. Methods: In this prospective observational study, 110 patients (aged 40\u201380) with facet-related CLBP underwent diagnostic MBBs using a double-block protocol. Spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), were measured on standing lateral radiographs. Clinical response was defined as a \u226580% reduction in Visual Analog Scale (VAS) scores. Data were analyzed using multivariate logistic regression and Receiver Operating Characteristic (ROC) curves. Results: Responders (n = 68) were significantly younger and had a lower BMI than non-responders (n = 42) (p &lt; 0.05). Non-responders exhibited significantly higher PI\u2013LL mismatch (18.6\u00b0 \u00b1 7.4 vs. 3.9\u00b0 \u00b1 4.2, p &lt; 0.001), higher PT (23.6\u00b0 \u00b1 5.1 vs. 17.4\u00b0 \u00b1 4.5, p &lt; 0.001), and lower LL (35.8\u00b0 \u00b1 7.2 vs. 45.2\u00b0 \u00b1 6.4, p &lt; 0.001). ROC analysis identified a PI\u2013LL mismatch threshold of &gt;12.5\u00b0 as the strongly associated with negative short-term diagnostic response (AUC = 0.892). Multivariate analysis confirmed that PI\u2013LL mismatch &gt; 12.5\u00b0 was a potential associated factor within the investigated model of poor response (OR: 4.25, 95% CI: 2.10\u20138.60, p &lt; 0.001), while age and BMI were not significant in the adjusted model. Conclusions: Sagittal spinopelvic malalignment, specifically an increased PI\u2013LL mismatch, is strongly associated with reduced diagnostic utility of MBB. Integrating biomechanical assessment into clinical decision-making may improve patient selection and treatment outcomes for facet-mediated pain.<\/jats:p>","DOI":"10.3390\/jcm15114354","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:11:04Z","timestamp":1780593064000},"page":"4354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spinopelvic Alignment as an Associated Factor of Short-Term Diagnostic Response to Lumbar Medial Branch Block: A Prospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-9373","authenticated-orcid":false,"given":"Burcu","family":"Ozalp","sequence":"first","affiliation":[{"name":"Department of Algology, Faculty of Medicine, Ege University, Izmir 35100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1657-7248","authenticated-orcid":false,"given":"Argun","family":"Pire","sequence":"additional","affiliation":[{"name":"Department of Algology, Faculty of Medicine, Ege University, Izmir 35100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2215-1518","authenticated-orcid":false,"given":"Gonul","family":"Sari","sequence":"additional","affiliation":[{"name":"Department of Algology, Faculty of Medicine, Adnan Menderes University, Ayd\u0131n 09100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meltem","family":"Uyar","sequence":"additional","affiliation":[{"name":"Department of Algology, Faculty of Medicine, Ege University, Izmir 35100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Eyigor","sequence":"additional","affiliation":[{"name":"Department of Algology, Faculty of Medicine, Ege University, Izmir 35100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunay","family":"Yolcu","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Celal Bayar University, Manisa 45030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1007\/s13244-018-0638-x","article-title":"Facet joint syndrome: From diagnosis to interventional management","volume":"9","author":"Perolat","year":"2018","journal-title":"Insights Into Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/papr.13287","article-title":"3. Pain originating from the lumbar facet joints","volume":"24","author":"Cohen","year":"2024","journal-title":"Pain Pract."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Roussouly, P., Pinheiro-Franco, J., Labelle, H., and Gehrchen, M. (2019). Sagittal Balance of the Spine: From Normal to Pathology: A Key for Treatment Strategy, Georg Thieme Verlag KG.","DOI":"10.1055\/b-0039-172090"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/21925682231162813","article-title":"The impact of spinopelvic alignment on the facet joint degeneration","volume":"15","author":"Soydan","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"071010","DOI":"10.1115\/1.4004493","article-title":"Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions","volume":"133","author":"Jaumard","year":"2011","journal-title":"J. Biomech. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"467","DOI":"10.14245\/ns.2346374.187","article-title":"From the spinopelvic parameters to global alignment and proportion scores in adult spinal deformity","volume":"20","author":"Cho","year":"2023","journal-title":"Neurospine"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Park, J.Y., Kim, D.H., Seo, D.K., Yoon, S.H., Lee, G., Lee, S., Park, C., Sim, S., and Suh, J.H. (2019). Predictors of response to a medial branch block: MRI analysis of the lumbar spine. J. Clin. Med., 8.","DOI":"10.3390\/jcm8040538"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3171\/2024.1.SPINE231199","article-title":"Effect of high disease activity on spinal sagittal malalignment in patients with rheumatoid arthritis","volume":"41","author":"Honda","year":"2024","journal-title":"J. Neurosurg. Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1093\/pm\/pnz248","article-title":"The effectiveness of radiofrequency ablation of medial branch nerves for chronic lumbar facet joint syndrome in patients selected by guideline-concordant dual comparative medial branch blocks","volume":"21","author":"Conger","year":"2020","journal-title":"Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1136\/rapm-2020-101597","article-title":"Consensus practice guidelines on interventions for lumbar facet joint pain: Finding a path through troubled waters","volume":"45","author":"Finlayson","year":"2020","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_11","first-page":"S1","article-title":"Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) guidelines","volume":"23","author":"Manchikanti","year":"2020","journal-title":"Pain Physician"},{"key":"ref_12","unstructured":"Bogduk, N. (2013). Practice Guidelines for Spinal Diagnostic and Treatment Procedures, International Spine Intervention Society (ISIS). [2nd ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1097\/BRS.0b013e3181ee6bd4","article-title":"Adult spinal deformity\u2014Postoperative standing imbalance: How much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","volume":"35","author":"Schwab","year":"2010","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1007\/s00586-010-1476-9","article-title":"Sagittal plane deformity: An overview of interpretation and management","volume":"19","author":"Roussouly","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00586-006-0294-6","article-title":"Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases","volume":"16","author":"Barrey","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_16","unstructured":"Bogduk, N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum, Elsevier Health Sciences."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E535","DOI":"10.36076\/ppj.2015\/18\/E535","article-title":"A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain","volume":"18","author":"Manchikanti","year":"2015","journal-title":"Pain Physician"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lv, X., Liu, Y., Zhou, S., Wang, Q., Gu, H., Fu, X., Ding, Y., Zhang, B., and Dai, M. (2016). Correlations between the feature of sagittal spinopelvic alignment and facet joint degeneration: A retrospective study. BMC Musculoskelet. Disord., 17.","DOI":"10.1186\/s12891-016-1193-6"},{"key":"ref_19","first-page":"e95747","article-title":"Correlation of Sagittal Spinopelvic Alignment Parameters with Pain and Functional Disability in Chronic Non-specific Low Back Pain","volume":"17","author":"Sarkar","year":"2025","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kim, H.J., Ban, M.G., Rho, M., Jeon, W., and Kim, S.H. (2022). Evaluation of sagittal spinopelvic alignment on analgesic efficacy of lumbar epidural steroid injection in geriatric patients. Medicina, 58.","DOI":"10.3390\/medicina58101383"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:28:18Z","timestamp":1780594098000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114354"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114354","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}