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PubMed2002

A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis.

STUDY DESIGN: The lumbar sacropelvis in 11 patients with myelomeningocele and kyphosis was treated with a subtraction kyphectomy technique and posterior instrumentation. The results of this procedure in the 11 patients were evaluated and compared with previous results. OBJECTIVE: To examine critically their experience using the subtraction (decancellation) vertebrectomy technique combined with posterior instrumentation for myelomeningocele kyphosis, the authors reviewed the charts of 18 myelomeningocele patients who underwent surgery for lumbar kyphosis between 1994 and 1998. SUMMARY OF BACKGROUND: The benefits of restoring sagittal spinal alignment in myelomeningocele patients with severe lumbar kyphosis deformity to achieve postural stability and improved sitting balance generally are accepted. The optimal method of deformity correction, the extent of instrumentation, and the role of limited arthrodesis remain undefined. METHODS: Of the 18 patients considered, 11 met the inclusion criteria of having undergone reconstruction using a subtraction (decancellation) vertebrectomy technique, preservation of the thecal sac, limited arthrodesis with posterior transpedicular lumbosacral instrumentation, and a minimum follow-up evaluation of 2 years. The study considered the age of the patient, number of levels fused, estimated blood loss, preoperative deformity, immediate postoperative correction, magnitude of correction, and maintenance of correction at latest follow-up assessment. RESULTS: The average age at the time of the index procedure was 6 years (range, 3-12 years). The average preoperative kyphosis was 88 degrees (range, 50-149 degrees ). Immediately after surgery, the average curve measurement was 3 degrees lordosis (range, 50 degrees to 50 degrees ). The average magnitude of postoperative sagittal plane deformity correction was 91 degrees (range, 43-126 degrees ). Finally, the magnitude of correction maintained at the final follow-up assessment averaged 66 degrees (range, 22-114 degrees ). This represented an average loss of correction at 2 years of 24 degrees (range, 0-84 degrees ). There were no deaths, episodes of acute-onset hydrocephalus, vascular complications, or chronic deep wound infections. CONCLUSIONS: The subtraction (decancellation) vertebrectomy technique with preservation of the dural sac is a safe and efficacious technique for correction and stabilization of myelomeningocele kyphosis in young patients. Morbidity is reduced, as compared with that of excision techniques. Restoration of sagittal alignment at the time of initial correction and stabilization to achieve a balanced spine led to acceptable results.

Blood Loss, Surgical↗
PubMed2003

Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy.

STUDY DESIGN: This retrospective study analyzed the effects of cervical alignment on surgical results of expansive laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM). OBJECTIVE: To determine the limitation of posterior decompression by ELAP for CSM in the presence of local kyphosis. SUMMARY OF BACKGROUND DATA: Several studies have reported that cervical malalignment affected surgical outcomes of ELAP. However, there has been no report to demonstrate crucial determinants of surgical outcomes of ELAP for CSM in relation to cervical sagittal alignment. METHODS: The study group comprised 114 patients who underwent ELAP for CSM. All were followed up for more than 2 years. The Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy (full score, 17 points) was used to evaluate surgical outcomes for each patient 2 years after surgery. Statistical analysis with multivariate logistic regression models was used to ascertain the risk factors affecting postoperative surgical outcomes. RESULTS: The average JOA scores were 9.9 points before surgery and 14 points 2 years after surgery. The recovery rate was 60.2%. Statistical analysis showed that signal intensity change on MRI and local kyphosis were the most crucial risk factors for poor surgical outcomes. Calculated with the logistic regression model, the highest risk of poor recovery was local kyphosis exceeding 13 degrees. CONCLUSIONS: The influence of cervical malalignment on neurologic recovery after ELAP for CSM was shown. When patients have local kyphosis exceeding 13 degrees, anterior decompression or posterior correction of kyphosis as well as ELAP should be considered. Expansive laminoplasty for CSM is best indicated for patients with local kyphosis less than 13 degrees.

Adult↗
PubMed2003

Scheuermann kyphosis: the importance of tight hamstrings in the surgical correction.

STUDY DESIGN: A historic cohort study of the sagittal alignment in 33 consecutive patients with surgically corrected thoracic Scheuermann kyphosis. OBJECTIVES: To determine if postsurgical imbalance, sagittal malalignment, and decreased lumbar-pelvic range of motion in patients with thoracic Scheuermann kyphosis is related to tight hamstrings. SUMMARY OF BACKGROUND DATA: Tight hamstrings are a frequent sign in Scheuermann kyphosis. The importance of tight hamstrings in the surgical management of Scheuermann kyphosis has not yet been studied. METHODS: Thirty-three patients with Scheuermann kyphosis were managed by surgical correction and fusion. Tight hamstrings, lumbar-pelvic range of motion, and sagittal balance were evaluated. Sixteen patients had tight hamstrings, and 17 patients had nontight hamstrings. Hamstrings were considered tight if the popliteal angle was >30 degrees. RESULTS: Patients with tight hamstrings have a significantly greater risk of postoperative imbalance (P = 0.05), and these patients can only compensate for this risk by reducing their lumbar lordosis (P = 0.0227). Furthermore, the limitations in the lumbar and pelvic range of motion are predicted by tight hamstrings (P <or= 0.005). CONCLUSION: Tight hamstrings can be considered as an important factor in the surgical management of thoracic Scheuermann kyphosis. Tight hamstring patients can be classified as "lumbar compensators" and as such are prone to overcorrection and imbalance. Preoperative assessment of the lumbar-pelvic range of motion and tight hamstrings should therefore be advised. Extensive fusion of the lumbar segments might compromise the lumbar compensation mechanism and induces further risk of imbalance.

Adult↗
PubMed2006

Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the Fracture Intervention Trial.

STUDY DESIGN: A study of agreement between different measures of kyphosis, a clinical standing measure (Debrunner kyphometer; Protek AG, Bern, Switzerland) versus a supine radiologic measure (Cobb angle). OBJECTIVES: To determine whether a supine radiologic measure of kyphosis in older women is a reasonable estimate of clinical kyphosis determined in the standing position, and to investigate a computerized assessment of the Cobb angle. SUMMARY OF BACKGROUND DATA: Few studies have investigated kyphosis measurement agreement involving older adults. METHODS: Using data from the Fracture Intervention Trial, we randomly selected 120 women, aged 55-80 years, who had a Debrunner kyphometer measure of kyphosis and supine lateral spine radiographs from which we measured the Cobb angle (either manually or by digitization). We calculated the intraclass correlation coefficient (ICC) from repeated measures analysis of variance to assess the agreement among the: (1) manual Cobb angle and Debrunner kyphometer, (2) digitized Cobb angle and Debrunner kyphometer, and (3) manual and digitized Cobb angle. RESULTS: The mean of both the manual and digitized Cobb angle was 45 degrees (range 18 degrees-83 degrees), and the mean Debrunner kyphometer reading was 48 degrees (range 17 degrees-83 degrees). The ICC between either of the 2 measures of the Cobb angle and Debrunner measurement was 0.68, indicating reasonable agreement. The ICC between the manual and digitized Cobb angle was 0.99, indicating excellent agreement. CONCLUSIONS: There is reasonable agreement between a supine radiologic and standing clinical measurement of kyphosis in older women.

Aged↗
PubMed2006

Posterior osteotomy and instrumentation for thoracolumbar kyphosis in patients with achondroplasia.

STUDY DESIGN: A retrospective case series of surgically treated achondroplastic patients with severe thoracolumbar kyphosis. OBJECTIVE: To evaluate the outcome of surgical treatment for thoracolumbar kyphosis in patients associated with achondroplasia presenting with paraparesis. SUMMARY OF BACKGROUND DATA: Thoracolumbar kyphosis is one of the frequent skeletal manifestations in patients with achondroplasia. Few papers have been published on the surgical treatment of this condition, especially in skeletally mature patients. METHODS: Four patients with achondroplasia who developed neurologic deficit due to severe thoracolumbar kyphosis and underwent surgical treatment were evaluated (mean age, 32.5 years; mean follow-up, 3.0 years). Posterior osteotomy with segmental instrumentation was performed in all cases. The surgical procedures included pedicle subtraction osteotomy in 2 patients without a hypoplastic apical vertebra and spondylectomy with reconstruction of the anterior column in 2 patients with a hypoplastic apical vertebra. Neurologic outcomes (JOA scores), correction of kyphosis, and operative complications were assessed. RESULTS: All patients had gait disturbance, and 2 patients were unambulatory before surgery. The average preoperative JOA score was 5.8 points, which was improved to 9.3 points at the final follow-up (mean recovery rate, 75%). All patients obtained neurologic improvement and became ambulatory either with or without crutches after surgery. The mean preoperative kyphotic angle was 96.3 degrees (range, 57 degrees -117 degrees ). The postoperative angles averaged 55.3 degrees (range, 30 degrees -110 degrees ), yielding a mean correction rate of 43.6%. Neither loss of correction nor pseudarthrosis has been observed during the follow-up period. Partial nerve root laceration and dural tear resulting in transient postoperative muscle weakness were observed in 2 patients as complications. CONCLUSIONS: Posterior spinal osteotomy with segmental instrumentation is a reasonable surgical option for thoracolumbar kyphosis in patients with achondroplasia. Modification of the surgical procedures depending on the presence or absence of the dysplastic changes of the apical vertebra is necessary to obtain optimal results.

Achondroplasia↗
PubMed1984

Kyphosis and pulmonary function in cystic fibrosis.

Spine deformity and chronic pulmonary disease are commonly seen in patients with cystic fibrosis (CF). In order to assess the prevalence of kyphosis, a retrospective evaluation of all initial standing chest radiographs of our CF patients matched with our "reference" population was undertaken. We also studied the possible correlation between the degree of kyphosis and the pulmonary function tests ( PFTs ), consisting of thoracic gas volume and maximal expiratory flows. In our population, the study confirmed an increased prevalence of kyphosis in CF patients (p less than .01), which occurred mostly in girls after 12 years of age (p less than .018). The kyphosis appeared to be, in most instances, of mild degree and was not related to any of the PFTs . No measurable increase of kyphosis was observed over a 3-year period in the group. Longer prospective study and the relationship of kyphosis to endocrine function in CF at puberty should be undertaken.

Adolescent↗
PubMed1996

Cervical kyphosis in patients who have Larsen syndrome.

Four patients who had Larsen syndrome and cervical kyphosis were managed operatively and followed for an average of seventy months (range, forty to ninety-two months). The preoperative cervical kyphosis ranged from 35 to 65 degrees. The patients had had a posterior cervical arthrodesis alone when they were infants, at an average age fo fourteen months (range, ten to sixteen months). In three infants, the kyphosis either stabilized (one patient) or reversed into lordosis (two patients). Thus, the kyphosis corrected gradually by continued anterior growth in the presence of a solid posterior fusion. In the fourth infant, the kyphosis progressed to 110 degrees because of pseudarthrosis. This child had anterior decompression and arthrodesis for an acute neurological deficit. We believe that cervical kyphosis is sometimes present but not diagnosed in patients who have Larsen syndrome. Early diagnosis followed by operative stabilization should help such patients avoid neurological deficits. Posterior cervical arthrodesis alone, performed in infancy, provided stability and the opportunity for the gradual correction of the deformity by continued anterior growth in three of our four patients.

Abnormalities, Multiple↗
PubMed2003

Kyphosis correction and height restoration effects of percutaneous vertebroplasty.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty is known for its pain-relieving effect. Our purpose was to evaluate its effect on the kyphosis angle, wedge angle, and height of the fractured vertebral body. METHODS: We reviewed digital radiographs of 73 vertebral bodies in 53 patients before and after vertebroplasty. We measured the spinal kyphosis angle and the wedge angle of the fractured vertebral body. Ratios of the height of the anterior border, center, and posterior borders of the collapsed vertebra to the height at the posterior border of an adjacent normal vertebral body were measured. Gain from vertebroplasty and the restoration percentage (gain divided by loss) were calculated for each parameter. RESULTS: The kyphosis angle, wedge angle, anterior height, center height, and posterior height significantly improved after vertebroplasty. The mean reduction in the kyphosis angle was 4.3 degrees, and the wedge-angle reduction was 7.4 degrees. The mean wedge-angle reduction in fractured vertebral bodies containing gas was 10.2 degrees. Restoration percentages for the kyphosis angle and wedge angle were 19% and 44%, respectively. Gain in the height of the fractured vertebral bodies was 16.7% for the anterior border, 14% for the center, and 7% for the posterior border. Restoration percentages for the height of the vertebral body were 29% for the anterior border and 27% for the center. CONCLUSION: Vertebroplasty increases the height of the fractured vertebra and reduces the wedge and kyphosis angles. These effects are most remarkable in fractured vertebra containing gas.

Aged↗
PubMed2006

[Kyphosis and kyphotic posture in children and adolescents].

Kyphosis is a sagittal deviation of the spine that presents as an anterior spinal curvature. It is a frequent reason for consultation during adolescence. It is necessary to know how to differentiate between a simple postural kyphosis that is flexible and reducible, and requires no further investigation, from a true kyphosis that requires at minimum a radiological evaluation with films of the entire spine, in AP and lateral views. If vertebral epiphysitis is most often at the origins of the sagittal vertebral deviations encountered in daily practice, the other causes pose diagnostic and therapeutic problems that are often more complex. They include congenital, paralytic, infectious, cancerous and post-traumatic kyphosis, or kyphosis due to constitutional bone diseases. Surgical treatments, that have only an exceptional place in treatment of the regular kyphosis of the adolescent, are potentially indicated in all of the other situations.

Adolescent↗
PubMed2006

[Treatment of kyphosis deformity with pedicle subtraction osteotomy and short-segment pedicle screw internal fixation].

OBJECTIVE: To assess the outcomes of pedicle subtraction osteotomy and short-segment pedicle screw internal fixation in kyphosis deformity. METHODS: From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtraction osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracture-dislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8 years. The whole spine radiographs were taken pre- and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, sacrohorizontal angle and distance between posterosuperior point of S1 and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. RESULTS: The mean follow-up period was 25. 6 months. The mean bleeding was 1100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6+/-16.4 degrees to 42.6 14.3 degrees (P<0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5+/-45.6 mm to 10.7+/-9.6 mm (P < 0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. CONCLUSION: Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.

Adult↗
PubMed1987

Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment.

From 1960 through 1978, a total of 274 patients who had a diagnosis of Scheuermann kyphosis were treated with a Milwaukee brace at the Twin Cities Scoliosis Center. We analyzed the long-term results in 120 patients who had used the Milwaukee brace and had been followed for at least five years after the completion of treatment. The average age of the patients at the initiation of treatment was twelve years and five months, the average age at the completion of treatment was sixteen years and one month, and the average age at the last follow-up examination was twenty-four years. Of the patients who wore the brace consistently, seventy-six showed improvement in the kyphosis between the initial evaluation and the evaluation at final follow-up, while twenty-four showed worsening and ten were unchanged. Seven of the twenty-four patients who were worse had had surgery before the review for this study. The indication for surgery was a kyphosis of more than 60 degrees that was increasing and was not controlled by the brace. Ten patients were inconsistent in their use of the brace. Two of the ten patients had improvement and eight had worsening of the kyphosis; three of the latter eight had a spinal fusion. This study showed that the Milwaukee brace is usually an effective method of treatment for patients who have Scheuermann kyphosis; however, four of fourteen patients who had an initial kyphosis of more than 74 degrees required a spinal fusion.

Adolescent↗
PubMed1991

Juvenile and idiopathic kyphosis. Long-term follow-up of 20 cases.

Twelve patients with juvenile kyphosis and eight patients with idiopathic kyphosis were reviewed at an average follow-up of 19 years. The average age of the patients at follow-up was 33 years (range 26-45 years). All the patients but one, who had a posterior fusion of the dorsal spine, had been treated with a plaster cast jacket followed by a plastic brace. At the end of treatment there had been an improvement of about 30% on the original curves in both juvenile and idiopathic kyphosis. At follow-up, however, all the patients had lost the correction obtained and the curves had become worse than originally, those in idiopathic kyphosis more so than those in juvenile kyphosis. Despite the increase in their angular deformity, all the patients managed fairly well and only two complained of distressing back pain.

Adolescent↗
PubMed2001

[Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease].

This report provides an overview of the history of the different types of kyphosis (arcuated and angulated forms). Especially tuberculous spondylitis and Scheuermann's disease are pointed out from among the large group of kyphotic diseases. Therefore, Beckhterew's disease, the combination of rickets and kyphosis as well as the dysraphic diseases and constitutional kyphosis caused by faulty posture are only mentioned. These two special types of kyphosis (Scheuermann's disease and tuberculous spondylitis) are presented from the first description with diagnostic findings, the ideas of pathogenesis and aspects of treatment through to the different periods of medical history. This article describes the way of thinking and discussing of opinion leaders at the beginning of the century and the influence of new techniques and developments (asepsis, antisepsis, anesthesia, bacteriology, X-ray, antibiotics) on the differential diagnosis and therapy. It is impossible to give a complete overview of all aspects during the centuries concerning tuberculous spondylitis or arcuated kyphosis. The authors of this article have focussed their studies on developments from the first descriptions until World War II, based mainly on literature from German journals and historical books from the library of the German Museum for Orthopedic History and Science.

Eponyms↗
PubMed1988

Operative fixation of fractures of the thoracic and lumbar vertebrae by Williams plates with reference to late kyphosis.

Thirty patients with fractures of the thoracic and lumbar spine, treated by the Williams plating technique (with or without fusion) between 1966 and 1978, were reviewed and followed up for an average of 6.5 years (range 2-14 years). The average degree of primary traumatic kyphosis was 11.4 degrees (range 0-33 degrees), and the average degree of late deformation kyphosis during follow-up was 17.4 degrees (range 0-30 degrees). The average loss of operative correction during follow-up was 9.8 degrees. Technical late complications, such as loosening of screws, occurred in half of the patients, but they did not affect the degree of spinal deformation. The corrective result, with reference to late deformity (kyphosis), largely correlated with the degree of primary traumatic kyphotic deformation and the severity of the neurologic lesion. The best late correction result was achieved with moderate primary kyphosis in patients with bursting fractures. Spinal fusion tended to give better results, especially in anterior wedge fractures, in maintenance of the correction of kyphosis, while laminectomy tended to give poorer results. None of the 15 patients with primary complete paraplegia showed improvement, while 80 per cent of patients with incomplete paraplegia made a moderate recovery.

Adolescent↗
PubMedDate not supplied

Comparison of thoracic kyphosis and postural stiffness in younger and older women.

BACKGROUND CONTEXT: An increase in thoracic kyphosis and postural stiffness is commonly associated with aging and many pathological conditions. Simple clinical measurements are needed to estimate the relative degree of postural stiffness to determine whether clinical interventions, such as exercise, are beneficial. PURPOSE: To compare the amount of kyphosis and postural stiffness in the thoracic spine of younger and older women. STUDY DESIGN/SETTING: Experimental design conducted at a large health science center in southeastern Texas. PATIENT SAMPLE: Fifty-one healthy adult women, 25 between the ages of 21 and 51 years and 26 aged 66 to 88 years. OUTCOME MEASURES: Index of kyphosis (IK) measured with a surveyor's flexicurve. Differences, percent change and ratios between IK measures taken in the relaxed and maximally erect positions were used to estimate postural stiffness. METHODS: Subjects were measured while standing in their usual relaxed posture and again in their maximally erect posture by three different raters. IK measures were calculated by each rater and averaged for further data analysis. Independent t tests were used to compare the two age groups at the .05 alpha level. RESULTS: Significant differences were found in both the relaxed (p= .018) and erect (p< .001) IK measures of younger and older women. The differences, percent change and ratio between the two IK measures were also significantly different in that the younger women demonstrated a greater degree of active reduction of their kyphosis (in the erect posture) than older women. CONCLUSIONS: Age-related differences in thoracic kyphosis and postural stiffness were documented between younger and older women by means of repeated flexicurve measurements performed in both a relaxed and a maximally erect position.

Adult↗
PubMed1996

The relative contribution of disc and vertebral morphometry to the angle of kyphosis in asymptomatic subjects.

In order to investigate the relative contributions of vertebra and inter-vertebral disk to kyphosis, a series of 100 asymptomatic healthy women (age range 39-91 years) were studied to evaluate lateral dorsal appearances and possible related parameters of bone loss. Subjects underwent lateral dorsal spine radiography and single photon absorptiometry of the radius. There was a significant decrease in physical height in relation to age (P < 0.001) and this was directly related to an increasing thoracic kyphosis (P < 0.005). The angle of kyphosis was better related to the average anterior disc height (P < 0.001) than to average anterior vertebral height. The vertebral body ratio, however (anterior/posterior height), was more strongly related to angle of kyphosis than was disk ratio. The results also showed a fall in the proximal and distal radial bone mineral content with age (P < 0.001). These findings suggest that dorsal kyphosis as part of the ageing process may be as closely related to the physical integrity of the disc as to the vertebral body. Hence, therapy for age related bone mineral loss may have limited effect on a kyphotic deformity of the dorsal spine in otherwise asymptomatic patients.

Absorptiometry, Photon↗
PubMed2000

Total en-bloc spondylectomy for correcting congenital kyphosis.

STUDY DESIGN: A case report of congenital kyphosis corrected using a total en-bloc spondylectomy. OBJECTIVES: To report a new surgical technique for the treatment of congenital kyphosis with myelopathy. SETTING: Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan. METHODS: A 16-year-old boy who showed a 61 degrees angular kyphosis and a 32 degrees scoliosis from T6 to T9 due to the failure of the vertebral bodies formation in T7 and T8 was treated with a total en-bloc spondylectomy. RESULTS: The kyphosis was corrected to 26 degrees (57.3%) and the scoliosis was corrected to 5 degrees (84.4%) postoperatively. Three years postoperatively, no loss of correction has occurred and the patient has no complaints. CONCLUSIONS: Total en-bloc spondylectomy is one of the useful surgical procedures for correction of congenital kyphosis Type I, with a high correction rate. Spinal Cord (2000) 38, 382 - 385.

Adolescent↗
PubMedDate not supplied

Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women.

Aging and osteoporosis have been associated with skeletal changes. Back extensor strengthening exercises are highly recommended for management of back pain, especially back pain related to osteoporosis. To our knowledge, the correlation of thoracic kyphosis, lumbar lordosis, and sacral inclination with back extensor strength, physical activity, and bone mineral density has not been critically studied in healthy, active, estrogen-deficient women. In a study of 65 such women (ages 48-65 yr), back extensor strength, bone mineral density, and physical activity score were evaluated and measured. These factors were then correlated with radiographic factors: (1) vertebral body ratios (anterior/posterior height) calculated for each vertebra from T-4 through L-5; (2) kyphosis index determined by adding the anterior heights of each vertebral body, T-4 through T-12, and then dividing the total by the corresponding sum of the posterior heights of each vertebral body; (3) thoracic kyphosis; (4) lumbar lordosis; and (5) sacral inclination. Back extensor strength had a significant negative correlation with thoracic kyphosis (r = -0.30, P = 0.019) and a positive correlation with lumbar lordosis (r = 0.26, P = 0.048) and sacral inclination (r = 0.34, P = 0.009). However, bone mineral density and physical activity score did not show any significant correlations with the radiographic factors. The results indicate that the stronger the back extensor, the smaller the thoracic kyphosis and the larger the lumbar lordosis and sacral inclination. We conclude that back extensor strength is an important determinant of posture in healthy women. However, prescribing back extensor strengthening exercises alone may also increase lumbar lordosis, which is not desirable.

Aged↗