{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:37:41Z","timestamp":1780641461006,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea funded by the Korean government","doi-asserted-by":"publisher","award":["2021R1F1A1045873"],"award-info":[{"award-number":["2021R1F1A1045873"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The aim of this study was to evaluate the impact of sagittal imbalance based on pelvic incidence\u2013lumbar lordosis (PI-LL) mismatch on the analgesic efficacy of epidural steroid injection in geriatric patients. Materials and Methods: Patients aged 65 years or older who received lumbar epidural steroid injections under fluoroscopy were enrolled. The cutoff of PI-LL mismatch &gt;20\u00b0 was used as an indicator of a marked sagittal imbalance. The cross-sectional area of the psoas and paraspinal muscles, as well as the paraspinal fat infiltration grade were measured. A 50% or more decrease in pain score at four weeks after injection was considered as good analgesia. Variables were compared between PI-LL \u2264 20\u00b0 and &gt;20\u00b0 groups and multivariate analysis was used to identify factors related to pain relief after injection. Results: A total of 237 patients consisting of 150 and 87 patients in the PI-LL \u2264 20\u00b0 and &gt;20\u00b0 groups, respectively, were finally analyzed. Female patients, patients with lumbar surgery history, and the smaller cross-sectional area of the psoas muscles were predominantly observed in patients with sagittal imbalance. There was no difference in analgesic outcome after injection according to the PI-LL mismatch (good analgesia 60.0 vs. 60.9%, p = 0.889). Multivariate analysis showed that pre-injection opioid use, moderate to severe foraminal stenosis, and high-graded paraspinal fat infiltration were significantly associated with poor analgesia after injection. Conclusions: There was no significant correlation between sagittal spinopelvic alignment and pain relief after lumbar epidural steroid injection for geriatric patients.<\/jats:p>","DOI":"10.3390\/medicina58101383","type":"journal-article","created":{"date-parts":[[2022,10,9]],"date-time":"2022-10-09T04:00:02Z","timestamp":1665288002000},"page":"1383","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of Sagittal Spinopelvic Alignment on Analgesic Efficacy of Lumbar Epidural Steroid Injection in Geriatric Patients"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2143-3943","authenticated-orcid":false,"given":"Hee Jung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Gi","family":"Ban","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miribi","family":"Rho","sequence":"additional","affiliation":[{"name":"Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7888-2128","authenticated-orcid":false,"given":"Woohyuk","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-7697","authenticated-orcid":false,"given":"Shin Hyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1097\/00007632-198811000-00019","article-title":"Lumbar degenerative kyphosis: Clinical, radiological and epidemiological studies","volume":"13","author":"Takemitsu","year":"1988","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E1561","DOI":"10.1097\/BRS.0b013e3182a63c29","article-title":"Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance","volume":"38","author":"Cho","year":"2013","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1097\/00007632-200109150-00017","article-title":"Dynamic sagittal imbalance of the spine in degenerative flat back: Significance of pelvic tilt in surgical treatment","volume":"26","author":"Lee","year":"2001","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1177\/2192568217699405","article-title":"Beyond Pelvic Incidence-Lumbar Lordosis Mismatch: The Importance of Assessing the Entire Spine to Achieve Global Sagittal Alignment","volume":"7","author":"Merrill","year":"2017","journal-title":"Glob. 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