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PubMedDate not supplied

[Ultrasound topometric measurements of thoracic kyphosis and lumbar lordosis in school children with normal and insufficient posture].

AIM: The posture of school children was examined in order to establish whether possible differences in clinically normal and insufficient posture can be detected by means of ultrasound topometry. METHOD: 105 healthy school children (56 female, 49 male) with an average age of 8 years (+/- 0.9) were examined. To classify the children as having sufficient or insufficient posture the Matthiass posture test was used. While the child stood in a relaxed position, the profile of the spine was measured with a topometric digitiser, recording each spinal processus from C7 to L5. RESULTS: 42 children (22 female, 20 male) showed an insufficient posture during the Matthiass test. The topometrically measured angles of kyphosis and lordosis were significantly smaller in these children, corresponding to a clinically greater thoracic kyphosis and lumbar lordosis. No significant differences in the lateral and anterior-posterior trunk deviation, nor in the range of trunk sway in the relaxed standing position could be observed. CONCLUSION: Using ultrasound topometry, the posture of children with sufficient and insufficient posture can be differentiated by measuring, the angles of kyphosis and lordosis. This quantification could be used for objective monitoring of the posture.

Anthropometry↗
PubMedDate not supplied

[Etiology of fixed lumbar lordosis: the lumbar dermoid].

Following a general survey of fixed lumbar lordosis the dermoids, in particular lumbar dermoids and their role in fixed lumbar lordosis, are described. Intralumbar dermoids must be regarded as a genuine rarity. The occurrence of fixed lumbar lordosis may be an early symptom. After radical removal restitutio ad integrum is possible. If any portion is left in situ the risk of recurrence is high. Follow-ups over a number of years are therefore mandatory.

Child↗
PubMed1996

The possibility of creating lordosis and correcting scoliosis simultaneously after partial disc removal. Balance lines of lumbar motion segments.

STUDY DESIGN: The feasibility of correcting scoliosis and creating lordosis simultaneously in the thoracolumbar and lumbar spine by anterior instrumentation was investigated by in vitro testing. OBJECTIVES: To evaluate the vertebral zones in which a compressive load applied in a motion segment creates side bending and lordosis in intact motion segments and after partial disc removal. SUMMARY OF BACKGROUND DATA: Most investigators have observed a kyphogenic effect of anterior scoliosis instrumentation and recommended dorsal placement of screws and the use of wedge grafts, although wedge grafts were not used routinely by all surgeons. METHODS: Zones of lordosization and side bending were determined by evaluation of balance lines between extension-flexion and side bending, respectively, by axial loading on ligamentous human motion segments with intact discs and after partial disc removal. RESULTS: In lumbar motion segments with intact discs, it is possible to achieve ipsilateral side bending and lordosization by anterior instrumentation. After partial disc removal, the balance line between extension and flexion runs through the ipsilateral pedicle, and, therefore, a compressive load between the vertebral bodies always creates kyphosis. CONCLUSIONS: After partial disc removal, it is not possible to create lordosis and correction of scoliosis simultaneously by ipsilateral anterior instrumentation without the use of intervertebral wedge grafts.

Adult↗
PubMed1998

Lumbar lordosis measurement. A new method versus Cobb technique.

STUDY DESIGN: A historic cross-sectional study of lumbar lordosis in 199 healthy individuals aged 1-30 years. OBJECTIVE: To evaluate the magnitude and rate of the development of the normal lumbar lordotic curve with age using two methods of measurement. SUMMARY OF BACKGROUND DATA: There is no agreement among spine physicians on the range of the normal lumbar lordotic curve. In certain conditions, such as a tethered spinal cord, a change in lordotic curve may indicate or even precede the onset of neurologic symptoms. Reliable measurements of the lumbar lordotic curve may aid in the early diagnosis and management of these conditions, before irreversible neurologic change ensues. METHODS: The lumbar lordotic curve was measured by the traditional Cobb technique and by a newly designed method, tangential radiologic assessment of lumbar lordosis. The data were subjected to the Morgan-Pitman test for correlated variances to observe which of the two methods was more reliable in measuring the magnitude and rate of change in the lumbar lordotic curve. RESULTS AND CONCLUSIONS: The rate of development of the lumbar lordotic curve appears to be nonlinear, increases during first year of life and during puberty, and reaches a plateau of approximately 50 degrees at maturity. The tangential radiologic assessment of lumbar lordosis method is more reproducible and more reliable in the lumbar lordotic curve, providing a smaller range of normal values (8 degrees-16 degrees less) than the Cobb method.

Adolescent↗
PubMed2001

Spinal lordosis with marked opisthotonus secondary to dystonia musculorum deformans: case report with surgical management.

STUDY DESIGN: A case report of severe spinal lordosis with marked opisthotonus and retrocollis secondary to dystonia musculorum deformans is presented. OBJECTIVE: To describe a case of dystonia musculorum deformans with progressive spinal lordosis and its surgical treatment. SUMMARY OF BACKGROUND DATA: Four patients with correction of coronal spinal deformity associated with dystonia musculorum deformans have been reported in the literature. No reports of sagittal spinal deformity treated with surgical instrumentation and fusion were found. METHODS: A retrospective chart and radiographic review of a single case was conducted. RESULTS: Orthotic management and pharmacologic therapy with botulinum toxin injections were unsuccessful in controlling the deformity. Severe spinal lordosis (170 degrees ) from occiput to sacrum was corrected surgically, allowing an upright posture. CONCLUSION: Dystonia musculorum deformans is a rare condition resulting in coronal or sagittal plane deformities. When other treatment methods are unsuccessful, surgical instrumentation and arthrodesis may correct the deformity and improve function.

Adolescent↗
PubMed2003

Reliability of the visual assessment of cervical and lumbar lordosis: how good are we?

STUDY DESIGN: Blinded test-retest design. OBJECTIVE: To measure the intrarater and interrater reliability of the visual assessment of cervical and lumbar lordosis. SUMMARY OF BACKGROUND DATA: Cervical and lumbar lordoses are frequently evaluated using visual assessment, but little attempt has previously been made to measure the reliability of visual assessment. METHODS: Twenty-eight chiropractors, physical therapists, physiatrists, rheumatologists, and orthopedic surgeons were recruited to evaluate the posture of photographed subjects (with and without back pain). Each clinician rated the lordosis of the cervical and lumbar spines as normal, increased, or decreased. Kappa coefficients (kappa) were calculated to determine intrarater and interrater reliability. RESULTS: Twenty-eight clinicians evaluated photographs of 36 individuals (17 with back pain, 19 without). Mean intrarater reliability was kappa = 0.50 (95% confidence interval 0.02-0.98) and mean interrater reliability was kappa = 0.16 (95% confidence interval 0.00-0.48). No statistically significant difference existed among the five groups of clinicians or between the evaluation of the subjects with and without back pain. CONCLUSION: Intrarater reliability of the visual assessment of cervical and lumbar lordosis was statistically fair, whereas interrater reliability was poor.

Adolescent↗
PubMed2006

Cantilever TLIF with structural allograft and RhBMP2 for correction and maintenance of segmental sagittal lordosis: long-term clinical, radiographic, and functional outcome.

STUDY DESIGN/SETTING: Prospective cohort study in a tertiary care spine center. OBJECTIVE: The effectiveness of the cantilever transforaminal lumbar interbody fusion (C-TLIF) technique in creating and maintaining lordosis, avoiding nerve problems, and obtaining fusion was studied. SUMMARY OF BACKGROUND DATA: C-TLIF is a microscope-assisted transforaminal lumbar interbody fusion technique, emphasizing no dural retraction with placement of structural allograft and RhBMP2 anteriorly under the cortical apophyseal ring, followed by middle column cancellous autograft placed under compression with posterior pedicle spinal instrumentation. METHODS: A total of 100 consecutive patients studied with an average of 30 months of follow-up. A total of 48 had prior surgery at the index level; 16 had the procedure done at an adjacent level to a previous fusion; 32 at L5-S1 with 42 at L4-L5 and 26 at L3-L4. There were 76 single-level and 24 two-level fusions. One patient was a smoker with one other patient a compensation case. Outcome was prospectively documented with self-administered Visual Analog Pain Scale, Oswestry Disability Questionnaire, Treatment Intensity Questionnaire, and SF-36 Health Survey. Patients rated the surgery as excellent, good, fair, or poor and whether they would recommend the surgery. Student t test was used for statistical analysis with significance set at P = 0.05. RESULTS: Blood loss and hospital stay averaged 300 mL and 2.2 days, respectively. There was significant reduction (P < 0.05) in pain scores from 9 to 3, Oswestry Disability Index scores from 35 to 12, and Treatment Intensity Score from 21/25 to 2/25 at final follow-up. The SF-36 PCS and MCS scores showed an increasing trend to improvement. A total of 69 rated the surgery as excellent, 23 good, 7 fair, and 1 poor. A total of 97% were satisfied and would recommend the surgery. All had improvement in radicular pain with no dural tears, neural injury, or neuropathic pain. There was significant improvement (P < 0.05) in segmental sagittal lordosis from 2 degrees to 9 degrees, anterior disc height from 6 to 14 mm, and posterior disc height from 4 to 8 mm. There was no subsidence, misplaced screws, or instrumentation failure. Solid fusion was obtained in 99 of 100 patients. CONCLUSIONS: The C-TLIF allows for creation and maintenance of sagittal lordosis while avoiding subsidence and neurologic problems with a 99% fusion rate and 97% patient satisfaction.

Adult↗
PubMed2002

Supportive cushions produce no practical reduction in lumbar lordosis.

It is common practice to place a pillow or bolster under the knees of patients undergoing lumbar spine CT or MRI. The use of such supportive cushions leads to gentle hip flexion that is thought to ease pain and "reduce lumbar lordosis". It is also thought to facilitate axial imaging through the discs. Observations in seven subjects who underwent lumbar spine MRI with and without such hip flexion showed no appreciable change in the degree of lordosis. As the use of such devices does not produce a practical reduction of lumbar lordosis, the decision to employ them should be made entirely with respect to patient comfort.

Beds↗
PubMed2003

The knee-spine syndrome. Association between lumbar lordosis and extension of the knee.

Degenerative changes of the knee often cause loss of extension. This may affect aspects of posture such as lumbar lordosis. A total of 366 patients underwent radiological examination of the lumbar spine in a standing position. The knee and body angles were measured by physical examination using a goniometer. Limitation of extension of the knee was significantly greater in patients whose lumbar lordosis was 30 degrees or less. Lumbar lordosis was significantly reduced in patients whose limitation of extension of the knee was more than 5 degrees. It decreased over the age of 70 years, and the limitation of extension of the knee increased over the age of 60 years. Our study indicates that symptoms from the lumbar spine may be caused by degenerative changes in the knee. This may be called the 'knee-spine syndrome'.

Adolescent↗
PubMed1981

Spinal pantograph - a non-invasive technique for describing kyphosis and lordosis in the thoraco-lumbar spine.

A spinal pantograph - a non-invasive method for describing and documenting the posture of the back in the standing position - is described. Thoracic kyphosis and lumbar lordosis can be recorded by a simple technique. A comparative study of the range of kyphosis and lordosis measured by X-ray and this mechanical device shows a statistically significant correlation. As regards the thoracic kyphosis, the spinal pantograph seems to be as accurate as the X-ray. In lumbar lordosis an underestimation is seen with the clinical device. Compared with non-scoliotic cases, a significantly decreased kyphosis is observed in structural scoliosis, even in cases with a scoliotic angle of less than 30 degrees according to Cobb. The advantage of this spinal pantograph is that it reduces the radiation dosage. It can be used for screening and follow-up examination of the posture especially during the growing stage.

Female↗
PubMed2002

Posterior pelvic tilt in patients with decreased lumbar lordosis decreases acetabular femoral head covering.

The relationship between pelvic tilt and acetabular femoral head covering was determined in 38 patients with decreased lumbar lordosis. Posterior pelvic tilt and acetabular femoral head covering were measured on radiographs taken in both supine and standing positions. Previously reported normal values obtained from 96 patients were used as controls. Posterior pelvic tilt increased (P<.01) in patients with decreased lumbar lordosis and anterior acetabular femoral head covering decreased (P<.0001) compared with the controls. These differences were more remarkable in the standing position than in the supine position. Patients with decreased lumbar lordosis have decreased femoral head covering, especially in the standing position.

Acetabulum↗
PubMed1999

The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis.

Degenerative spondylolisthesis (DS) is a common condition of the aging spine, but the underlying pathomechanisms remain controversial. Most previous studies focused on the role of facet-joint alignment and reported a pronounced sagittal orientation. This, however, may also be a secondary feature to the slippage. This study analyzed several radiologic findings in the lower lumbar spine in 23 patients with DS (group A) and 40 age- and sex-matched controls (group B). Facet-joint angulation, intervertebral disc height, lordosis of the lumbar spine (L1-S1), and inclination of the L4, L5, and S1 end plates were assessed from neutral standing lateral radiographs and computed tomography (CT) or magnetic resonance imaging (MRI) investigations. Two findings were found to be significantly different between the groups. Facet joints were aligned more sagittal in group A, and the inclination of the vertebral end plates was more horizontal in group B. There was no statistical difference in lumbar lordosis or L4-5 disc height between the two groups, with disc height being decreased in both groups. In group A, more gliding was associated with a further decrease in disc space, pronounced sagittal alignment of the L4-5 facet joints, and a decrease in lumbar lordosis. We concluded that further studies should focus on the analysis of spinal alignment and lower lumbar end-plate orientation to identify patients at risk for development of DS.

Aged↗
PubMed1999

Effect of changes in lordosis on mechanics of the lumbar spine-lumbar curvature in lifting.

Using a realistic nonlinear three-dimensional finite element model, biomechanics of the entire lumbar spine L1-S1, risk of tissue injury, and required local lumbar muscle exertion in extended and flexed postures are investigated under moderate to relatively large compression loads as great as 2800 N as the lumbar lordosis is altered from the undeformed value of -46 degrees by + 15 degrees in extension or by as much as 38 degrees in flexion. To prevent the instability of the passive structure in compression, the changes in segmental rotations are prescribed and the required sagittal/lateral moments at each level calculated. The effect of load distribution is considered by applying the whole compression on the L1 vertebra alone or among all vertebral levels with 90% or 80% of the compression on the L1 and the remaining evenly shared by the rest. The results are markedly affected by the postural changes and load distributions. The primary global displacement responses are stiffened in the presence of combined loads. The axial compression load substantially increases the intradiscal pressure, facet loads, and disc fiber strains. The large facet loads at the caudal L5-S1 level causes large differential sagittal rotations at vertebral posterior and anterior bony structures, resulting in large stresses in the pedicles and pars interarticularis. The contribution of the passive structures in carrying the load is influenced by the lumbar lordosis and compression load magnitude. Slight flattening of the lumbar spine under large compression reduces the maximum disc fiber strains and required equilibrating moments without adversely affecting the disc pressure and ligament forces. During lifting tasks, the passive spinal structures are protected by slight to moderate flattening in the lumbar curvature, whereas larger flexion angles impose significantly higher risk by increasing the disc pressure, disc anulus fiber strains, ligamentous forces, and facet forces. Changes in lordosis also markedly affect the stabilizing sagittal moments; the required moments diminish in small flexion angles, thus requiring smaller forces in local lumbar muscles. Thus, the lumbar posture during heavy lifting could be adjusted to minimize the required moments generated by lumbar muscle exertions and the risk of tissue injury.

Aged↗
PubMedDate not supplied

Estimated kyphosis and lordosis changes at follow-up in patients with idiopathic scoliosis.

The objective of this study was to verify the accuracy of surface measurements to estimate the magnitude of sagittal curvature changes at follow-up. Ninety-seven patients with idiopathic scoliosis were evaluated at two different visits (interval: 15.7 months). Kyphosis and lordosis were measured on the lateral radiograph. Surface measurements rely on localization of spinous process landmarks using a video-based system. Multiple regression analyses were performed to estimate the sagittal curvatures on the second visit. The regression was significant for both kyphosis and lordosis. The mean absolute difference between the estimate and the radiologic measurement was 3.3 degrees for kyphosis and 3.2 degrees for lordosis. The difference between the estimated change and the observed change between visits showed mean absolute differences of 3.4 degrees and 2.7 degrees, respectively. The proposed strategy could be used during follow-up to reduce patient irradiation without loss of sagittal information.

Adolescent↗
PubMed1999

Effects of kyphosis and lordosis on the remaining lumbar vertebral levels within a thoracolumbar fusion: an experimental study of the multisegmental human spine.

This study was done to determine the motion of the whole lumbar spine after internal fixation and the effect of kyphosis and lordosis on the remaining vertebral levels. Baseline motion analysis of sagittal, frontal, and transverse planes was done to determine the intact range of motion. Three fusion configurations were tested: neutral position (0 degrees), 4.6 degrees +/- 2.0 kyphosis, and -6.2 degrees +/- 3.6 lordosis. The sagittal and frontal plane relative rotation of the instrumented segments (T12/L2) decreased an average of 74% and 60%, respectively, as compared with intact testing. Sagittal plane motion at the remaining segments increased for all fusion configurations when compared with intact motion and reached statistical significance at the L4/L5 level. No significant differences were found between fusion configurations (ie, fused neutral, kyphosis, and lordosis).

Aged↗
PubMed1991

[Lumbar lordosis: radiological classification and biomechanical consequences].

Various radiological parameters were measured on a lateral film taken in erect position of the lumbar spine in 55 patient with low back pain. These various parameters had inter-, intra-observer and inter-study variation coefficients of less than 3%. In patients with a positive Fergusson index ("low" or inferior lordosis), mean values of the angle of lordosis and of obliqueness of the lower vertebral plateau of L5 in relation to the horizontal were higher than in patients with a negative Fergusson index ("high" or superior lordosis), this being statistically significant. In view of the correlations found between the various parameters measured and this classification, the biomechanical consequences, which have their role to play in the management of patients with low back pain, are discussed.

Adult↗
PubMedDate not supplied

Thoracic lordosis in idiopathic scoliosis.

Lordosis, a significant aspect of thoracic scoliosis, is difficult to assess with routine clinical radiographs. Computerized analysis of 138 sets of standardized anteroposterior and lateral radiographs served to elicit the three-dimensional structure of scoliosis. Spinal curvatures in the usual anatomic planes and in the sagittal and frontal planes of the apical vertebrae were measured. Lordosis was present in 35% of curves greater than or equal to 40 degrees and in 50% of curves greater than 49 degrees. Lordosis may be a contraindication for brace treatment.

Anthropometry↗
PubMed1979

[Relationships between the height of intervertebral discs and the degree of lordosis of the cervical spine in children. A roentgenometric study (author's transl)].

On lateral roentgenograms of the cervical spine of 120 normal children between 3 and 14 years of age the ventral and dorsal height of all 5 intervertebral discs were measured and the "index of the intervertebral disc" was calculated. In addition, the "degree of lordosis" of the cervical spine was determined according to ISHIHARA (1964). Evaluation was in 3 age groups: 3 to 6, 7 to 10, 11 to 14 years; and the arithmetic mean and standard deviation were calculated for each group. All intervertebral discs are more or less "cuneiform" (ventrally higher than dorsally); they narrow from cranial to caudal. In children the degree of lordosis of the cervical spine shows a continuous decrease with advancing years. In all age groups girls show a lower degree of lordosis than boys. Statistically the differences of average values of the intervertebral-disc-index among the various shapes of the cervical spine in neutral position (straight, sublordotic, lordotic and hyperlordotic) are highly significant. By means of roentgenometric methods our examinations demonstrate that the lordotic curvature of the healthy cervical spine primarily depends on the cuneiform shape of intervertebral discs.

Adolescent↗