Objective: Spinal disc degeneration and muscle atrophy with aging lead to reduced lumbar lordosis and sagittal imbalance. The body compensates by pelvic retroversion, which maintains posture but may increase disability despite preserved mobility. This study examined the relationship between pelvic retroversion and pain, disability, and quality of life in patients with low back pain.
Materials and
Methods: A cross-sectional analysis was conducted on 122 patients presenting with low back pain. Patients with prior spinal surgery, advanced hip pathology, or major coronal deformities were excluded. Pain and disability were assessed using the Visual Analog Scale (VAS), Oswestry disability index (ODI), and Roland-Morris questionnaires. Standing full-length lateral radiographs were obtained to measure spinopelvic parameters. Pelvic retroversion was categorized according to the global alignment and proportion scoring system. Regression and correlation analyses were used to evaluate associations between radiological and clinical outcomes.

Results: The mean patient age was 43.5 years, and 47.6% exhibited pelvic retroversion. VAS scores did not differ significantly between retroversion groups. However, disability indices showed significant variation: Patients with severe retroversion demonstrated higher ODI scores, while those with mild retroversion had higher Roland-Morris scores compared with the balanced pelvis group. Multiple regression revealed that a balanced pelvis was associated with a 9-point lower ODI
score. Negative correlations were observed between pelvic retroversion and both ODI (rs=−0.31) and Roland-Morris scores (rs=−0.28).

Conclusion: Pelvic retroversion, though a compensatory mechanism for sagittal imbalance, is more strongly associated with disability and quality of life than with pain severity. The results highlight the importance of evaluating pelvic tilt in low back pain patients, even in the absence of structural deformity. Routine radiographic assessment of pelvic parameters may identify individuals at risk for functional decline and guide timely preventive strategies.