Association Between Trendelenburg Sign and Lumbar MRI Abnormalities

Association of the Trendelenburg Sign With Spinopelvic Biomechanics and Lumbar MRI Abnormalities"

The Trendelenburg sign is a common clinical finding indicating hip abductor dysfunction and altered pelvic stability. The relationship between the Trendelenburg sign, spinopelvic biomechanics, hip muscle strength, and lumbar magnetic resonance imaging (MRI) abnormalities remains insufficiently understood. This study aims to investigate the association between Trendelenburg sign positivity and lumbar MRI findings, including facet arthropathy, ligamentum flavum hypertrophy, multifidus muscle morphology, and psoas muscle characteristics, as well as spinopelvic biomechanical parameters and hip abductor muscle strength.

Study Overview

• Status: Not yet recruiting
• Conditions: Lower Back Pain; Facet Joint Arthropathy

Detailed Description

The Trendelenburg sign is a clinical indicator of hip abductor muscle dysfunction and altered pelvic stability. Changes in hip abductor function may affect spinopelvic biomechanics and contribute to lumbar degenerative changes. This prospective observational study aims to investigate the association between Trendelenburg sign positivity and lumbar MRI abnormalities in adults with chronic low back pain.

Participants will be classified as Trendelenburg-positive or Trendelenburg-negative based on clinical examination. Hip abductor muscle strength and lumbar MRI findings will be evaluated. MRI parameters will include the presence and severity of facet joint arthropathy, ligamentum flavum thickness, multifidus muscle thickness, and psoas muscle characteristics.

The primary objective is to determine whether a positive Trendelenburg sign is associated with lumbar facet arthropathy. Secondary objectives include evaluating the relationships between the Trendelenburg sign, hip abductor strength, and other lumbar MRI parameters. The findings may improve understanding of the biomechanical relationship between hip function and lumbar degeneration in patients with chronic low back pain.

• Study Type: Observational
• Enrollment (Estimated): 120

Contacts and Locations

• Study Contact: Name: zeynep Iyigun, Prof. MD; Phone Number: +905056987368; Email: zeynep.iyigun@bau.edu.tr

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Bahcesehir university

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18-65 years with low back pain and available lumbar MRI scans obtained within the previous 12 months. Participants will undergo clinical assessment for Trendelenburg sign and hip function, and lumbar MRI evaluation for degenerative changes.

Description

Inclusion Criteria:Age between 18 and 65 years. Patients who have previously presented to the clinic with a complaint of low back pain.

Willingness and ability to provide written informed consent for participation in the study.

Availability of lumbar MRI images obtained within the previous 12 months and accessible for evaluation.

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Exclusion Criteria:Presence of red flag conditions associated with low back pain, including malignancy, infection, acute trauma, or significant neurological deficits.

History of lumbar spine surgery. Structural spinal anomalies such as sacralization or lumbarization. Spinal deformities, including scoliosis. Rheumatologic diseases affecting the spine (e.g., axial spondyloarthritis). Significant radiculopathy or advanced neurological deficits, and the presence of extruded or sequestrated lumbar disc herniation.

Clinically significant lumbar spinal stenosis. Spondylolysis and/or spondylolisthesis. Acute vertebral fracture, compression fracture, or recent fracture associated with severe osteoporosis.

Hip or pelvic conditions that may directly influence the Trendelenburg sign, including:

History of hip arthroplasty or hip surgery, Advanced hip osteoarthritis, Residual deformity following lower-extremity fracture, Significant leg length discrepancy (>2 cm). Systemic or neuromuscular disorders, including multiple sclerosis, myopathies, amyotrophic lateral sclerosis (ALS), stroke, or peripheral neuropathies.

Pregnancy. Severe knee or ankle pathology or other conditions causing substantial gait impairment.

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Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence and Severity of Lumbar Facet Joint Arthropathy	Assessment of the presence and severity of lumbar facet joint arthropathy on magnetic resonance imaging (MRI) and its association with Trendelenburg sign positivity.	Baseline

Collaborators and Investigators

• Sponsor: Bahçeşehir University

Study record dates

Study Major Dates

• Study Start (Estimated): June 4, 2026
• Primary Completion (Estimated): August 25, 2026
• Study Completion (Estimated): October 10, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: BAU-FTR-2026-07/04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared to protect participant confidentiality and in accordance with institutional regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No