Methods: Overall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups. Results: As SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p<0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p<0.05 for every comparison). Conclusions This study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA.

The objectives of this study were 1) to quantify the differences in body densities and percent body fat using various methods for evaluating body composition (e.g., underwater weighing (UWW), air displacement plethysmography (ADP), skinfold caliper (SKF) measurement, ultrasound (US), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA)), and 2) to examine the relationship between trends of the differences in body density and percent body fat obtained by these methods and characteristics of morphology and body composition. To this end, the body compositions of 73 healthy male adults were measured using UWW, ADP, SKF, US, and BIA. Twenty-seven of these 73 subjects underwent further measurement using DXA. Differences in body densities determined with ADP, SKF, and US were compared with those measured using UWW as a reference, and the differences in percent body fat estimated with UWW, ADP, SKF, US and BIA were compared with those measured by DXA as a reference. The results of this study indicate that 1) ADP is useful as a method for evaluating body density, as the results differed insignificantly from the reference method and showed no systematic errors due to differences in morphological characteristics and body composition, and 2) UWW measurements exhibited the smallest difference in percent body fat from the reference method, however, more than in any other method, there were systematic errors due to differences in morphological characteristics and body composition, specifically, trunk composition.