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PubMed1998

Peripubertal ontogeny and estrogen stimulation of cholecystokinin and preproenkephalin mRNA in the rat hypothalamus and limbic system.

The neuropeptide cholecystokinin (CCK) is expressed in limbic system and hypothalamic nuclei that form a circuit that regulates the display of the female rodent reproductive behavior, lordosis. CCK mRNA and peptide levels fluctuate across the estrous cycle and have been shown to be modulated by estrogen exposure. The objective of these experiments was to examine the expression of CCK mRNA during postnatal development of this limbic-hypothalamic, lordosis regulating circuit, and to determine the age at which CCK mRNA expression becomes responsive to estrogen stimulation, by using quantitative in situ hybridization histochemistry. CCK mRNA levels were below the level of detectability within the circuit during the postnatal period, but increased during the peripubertal period. Rats were injected with either estradiol benzoate (EB), EB and progesterone, progesterone, or oil, and were killed 48 hours later on postnatal day (PND) 15, 20, and 25. Alternate brain sections were processed for CCK and preproenkephalin (PPE) mRNA in situ hybridization histochemistry. EB treatment induced CCK mRNA expression in the central portion of the medial preoptic nucleus and posterodorsal medial amygdala at PND 20 and 25, respectively. However, EB treatment increased PPE mRNA levels within the nuclei of the circuit at all ages examined. Progesterone had neither an independent nor additive effect on the EB induction of these neuropeptide messages. The estrogenic induction of CCK mRNA appears to be dependent on estrogen sensitive pathways of neurotransmission, or components of second messenger pathways which regulate CCK mRNA expression in the adult limbic-hypothalamic lordosis regulating circuit, which are not functional before PND 18-25.

Animals↗
PubMed1981

Ultrasonographic determination of lumbar spine angulation.

Abdominal ultrasonograms of recumbent, supine adult subjects were used to measure the angle formed between the horizontal plane and a plane along the anterior border of upper lumbar vertebral bodies. The angle, referred to as phi, for male and female subjects averaged 8.8 degrees. When this angle was compared in subjects with the hips flexed and extended, there was no significant difference. There was a significant difference between subjects in a recumbent position and a standing position. The amount of angulation was compared to the age of the individual and found to have a low correlation coefficient. The angle phi appears to be a good indicator of the amount of lordosis, it related well to previous methods of measuring lordosis, and it is a benign procedure in a genetically sensitive region.

Adult↗
PubMed1994

Perinotochordal connective sheet of gilthead sea bream larvae (Sparus aurata, L.) affected by axial malformations: an histochemical and immunocytochemical study.

BACKGROUND: Spinal malformations in adult teleosts occur under natural conditions and, more frequently, in culture exploitations. Skeletal deformities are linked with dysfunctions in collagen metabolism. We studied axial deviations appearing in early larval stages of cultured sea bream (Sparus aurata, L.). METHODS: To evaluate connective tissue components of normal and lordotic fish we used histochemistry (alcian blue, picrosirius-polarization, clorhydric orcein, fuchsin resorcin), immunohistochemistry (anti-collagen I, II, III, and IV), and specific enzymatic digestions. The results were evaluated by semiquantitative methods. RESULTS: Lordosis appeared before a vertebral column was developed, thus affecting the only skeletal structure present in the animal body, the notochord. At this stage the animal depends on the vitelline sac and an inflated swim-bladder is missing. The region of the curvature showed strong alterations in the arrangement of the muscle bundles and irregularities in notochord and perinotochordal collagen sheet. Histochemical and immunocytochemical analysis of the perinotochordal sheet revealed the presence of type II collagen, non-sulfated glycosaminoglycans, and elastic fibers in normal and lordotic specimens. Low collagen-proteoglycan interactions occurred in lordotic animals. CONCLUSIONS: Lordosis in Sparus aurata originated during embryonic development and was characterized by disorganized connective tissue and muscle bundles. No major differences in connective tissue constituents were seen with respect to normal specimens.

Animals↗
PubMed1976

[Scoliosis, metabolism and growth of the vertebral column (author's transl)].

Modern investigators incline to the opinion, that more biochemical than biomechanical disorders take part in cause of the "idiopathic'' scolioses. It seems, however, that there is not only one cause but more in some subgroups. Idiopathic scolioses, which have symptomes of arachnodactyly, seem to be a big one of these subgroups. These cases allow to state a hypothesis, in which kind a disordered metabolism leads to a deviation of the spine. This hypothesis is basing on the fact, that the enchondral growth in the length and the periostal growth in the width of "long bones'' are not regulated in the same endocrinological kind and that the enchondral growth of the vertebral-bodies-column happens in cranio-caudal direction, the enchondral growth of the vertebral-archies-column, however, in anterior-posterior direction. If the balance between enchondral and periostal growth is disturbed, you can see typical chances on the long bones, which resemble either an "arachnodactyly" or a "chondrodysplasy". The same disturbance will cause a "kyphosis" respectively a "lordosis" (or scoliosis) on the vertebral spine; either the bodies-column or the archies-column will become longer (higher). The results of metabolism research are suitable to these facts. If the balance between enchondral and periostal growth,--basing on a dysbolism,--is disturbed in such a kind, that the vertebral-bodies-column is growing faster than the vertebral-archies-column, the vertebral spine is forced to change into a lordosis respectively into a scoliosis. If you want to cure an idiopathic scoliosis, you first have to remove or to paralyse the dysbolism. The aim of all research has to be to find an effective chemotherapeutical treatment of mindst a part of all idiopathic scolioses.

Achondroplasia↗
PubMed2003

Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis.

The objective of the study was to evaluate the impact of postural deformities and spinal mobility on quality of life (QOL) in patients with spinal osteoporosis. A total of 157 postmenopausal women aged over 60 years with osteoporosis were divided into five groups according to their postural deformities: round back (RB, n=41), hollow round back (HRB, n=33), whole kyphosis (WK, n=40), lower acute kyphosis (LAK, n=18), and normal posture (NP, n=25). QOL was evaluated using the Japanese Osteoporosis QOL Questionnaire (JOQOL) proposed by the Japanese Society for Bone and Mineral Research. This questionnaire contains six domains, with higher scores indicating higher levels of QOL. The number of vertebral fractures, thoracic kyphosis and lumbar lordosis angles, and spinal range of motion (ROM) during maximum flexion and extension were also measured with radiographs. Total QOL scores in RB, HRB, WK, and LAK groups were significantly lower than those in the NP group, and those in WK group were even lower compared with the other groups ( P<0.05). All the groups with postural deformities, but not the NP group, showed significant positive correlations between total QOL score and spinal ROM (0.521</= r</=0.747, P<0.05). Total QOL score showed a significant correlation with age, number of vertebral fractures, lumbar lordosis angle, and spinal ROM in a total of 157 patients. However, multiple regression analysis revealed that spinal ROM best correlated with total QOL score. We concluded that QOL in patients with osteoporosis was impaired by postural deformities, especially by whole kyphosis, and that spinal mobility has a strong effect on QOL in these patients.

Activities of Daily Living↗
PubMed2002

Muscle force evaluation and the role of posture in human lumbar spine under compression.

Using two nonlinear finite element models of the lumbar spine, the concept of optimal posture is explored by minimizing the segmental sagittal moments required for the equilibrium of the passive lumbar spine under a total of 2800 N axial compression while varying the pelvic tilt and lumbar lordosis. The redundant active-passive system is subsequently solved for this posture using a novel kinematics-based muscle calculation algorithm along with minimization approach. Some flattening in the lumbar spine substantially reduces the required moments and internal passive shear forces under 2800 N axial compression force. Small muscle forces are calculated for this optimal posture. The role of flattening in the lumbar lordosis and posterior pelvic tilt in diminishing the lumbar muscle activities in neutral postures is demonstrated. Without such changes in posture, the required moments probably exceed the moment-generating capability of local lumbar muscles. Consideration of such active-passive synergy and lack of its restriction may prove crucial in many activities. Moreover, a kinematics-based algorithm is proposed for the solution of spinal redundancy that fully accounts for the existing passive-active synergy while simultaneously satisfying all kinematics and equilibrium conditions along the length of the spine.

Biomechanical Phenomena↗
PubMed2006

Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis.

Sagittal spinopelvic relations have been reported in adolescent idiopathic scoliosis (AIS), but there is little information on their effect following surgery. The objective of this study is to evaluate the relation between the pelvic and lumbar spine geometries following posterior spinal instrumentation and fusion (PSIF). Sixty patients with AIS undergoing PSIF were studied retrospectively. Thoracic kyphosis (TK), lumbar lordosis (LL), LL within and below fusion, pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT) were measured on preoperative and postoperative standing lateral radiographs. Significant postoperative correlations were found between PI and LL (r = 0.67), SS and LL (r = 0.90), PI and LL below fusion (r = 0.40), SS and LL below fusion (r = 0.48). Pelvic parameters did not influence LL within fusion. A strong correlation was found between LL below and within fusion (r = -0.76). The close interdependence between lumbar lordosis and pelvic geometry preoperatively is maintained postoperatively following PSIF. In the planning of surgery for AIS, it may be helpful to evaluate the sagittal pelvic morphology (PI) in addition to the spinal curves. Preoperative evaluation of the pelvic morphology could be used to optimize intraoperative positioning of the patient and to determine the optimal amount of LL that needs to be restored or preserved by the instrumentation, so that LL remains congruent with the pelvic morphology.

Adolescent↗
PubMed2006

The association between cervical spine curvature and neck pain.

Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent. The aim of this study was to examine the correlation between the presence of neck pain and alterations of the normal cervical lordosis in people aged over 45 years. One hundred and seven volunteers, who were otherwise undergoing treatment for lower extremity problems in our hospital, took part. Sagittal radiographs of the cervical spine were taken and a questionnaire was completed, enquiring about neck pain and disability in the last 12 months. Based on the latter, subjects were divided into a group with neck pain (N = 54) and a group without neck pain (N = 53). The global curvature of the cervical spine (C2-C7) and each segmental angle were measured from the radiographs, using the posterior tangent method, and examined in relation to neck complaints. No significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity (P > 0.05). Twenty-three per cent of the people with neck pain and 17% of those without neck pain showed a segmental kyphosis deformity of more than 4 degrees in at least one segment--most frequently at C4/5, closely followed by C5/6 and C3/4. The average segmental angle at the kyphotic level was 6.5 degrees in the pain group and 6.3 degrees in the group without pain, with a range of 5-10 degrees in each group. In the group with neck pain, there was no association between any of the clinical characteristics (duration, frequency, intensity of pain; radiating pain; sensory/motor disturbances; disability; healthcare utilisation) and either global cervical curvature or segmental angles. The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain. This should be given due consideration in the differential diagnosis of patients with neck pain.

Age Factors↗
PubMed1999

Long-term results in patients treated with posterior instrumentation and fusion for degenerative scoliosis of the lumbar spine.

The authors report a homogeneously investigated and surgically treated series of 40 patients with degenerative scoliosis of the lumbar spine. The series included 22 females and 18 males with a mean age of 62.8 years. The clinical presentation, the diagnostic work-up, the indication for surgery, the surgical techniques and results are reported. Final evaluation was possible in 30 patients at a mean period of observation of 59.5 months. Following a very precise diagnostic and therapeutic protocol excellent, good and satisfactory surgical results were obtained in 13 (43.3%), 16 (53.3%) and 1 (3.3%) patients, respectively. While scoliosis was converted from a mean preoperative Cobb angle of 18.7 degrees to 7.6 degrees mean pre-operative lumbar lordosis was slightly augmented from 37 degrees to 41.5 degrees. The results suggest that maintainance or correction of lumbar lordosis is more important than the conversion of the scoliotic deformity which is probably treated sufficiently by partial correction and stabilization. Observation over time indicates that the degenerative cascade evolves despite internal fixation and fusion in the majority of the patients until a stable state is reached. This stable state is probably rather the result of ankylosis of the facet joints than the effect of posterolateral fusion.

Adult↗
PubMed1988

Nerve growth factor-mediated sexual differentiation of the rat hypothalamus.

Injection of antibody to nerve growth factor into the cerebral lateral ventricle blocked testosterone-induced behavioral defeminization of neonatal female rats. When tested as adults following ovariectomy and combined estrogen-progesterone treatment, the injected animals showed a significantly higher lordosis quotient than the testosterone-treated, normal rabbit serum-infused controls. Failure of vaginal opening and clitoral enlargement manifested the well-documented masculinizing effect of testosterone on the genitalia in the experimental as well as the control animals. Estrogen sensitivity of hypothalamic neurons which are responsible for the induction of lordosis was retained in the experimental animals. Recordings of the antidromic action potentials from neurons in the ventromedial nucleus of the hypothalamus following stimulation of the midbrain central gray revealed that estrogen decreased the antidromic activation threshold and shortened the absolute refractory period of the hypothalamic efferents along with the estrogen-induced behavioral activation in the experimental animals. In the control group, the estrogen-induced neuronal activation was lost altogether with the behavioral activation.

Action Potentials↗
PubMed2005

Bilateral C5 motor paralysis following anterior cervical surgery--a case report.

Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. Bilateral C5 nerve root deficits were noticed in the immediate postoperative period, and treated non-operatively. A postoperative magnetic resonance imaging (MRI) scan showed an increase in cervical lordosis accompanied by a posterior shifting of the spinal cord. Potential mechanisms of nerve root injury in this situation are discussed, and the literature on postoperative C5 root deficits is reviewed. The patient returned to his preoperative occupation as an operating room nurse 6 months following surgery, with complete neurologic recovery occurring over an 11-month period. C5 deficits following anterior cervical surgery occur more frequently than generally assumed. Improved lordosis and longitudinal lengthening of the cervical spinal column in multilevel anterior decompression and interbody fusion can paradoxically result in a traction injury to the spinal cord and C5 nerve roots.

Bone Transplantation↗
PubMed1995

Postural aberrations in low back pain.

The purpose of this study was to measure and describe postural aberrations in chronic and acute low back pain in search of predictors of low back pain. The sample included 59 subjects recruited to the following three groups: chronic, acute, or no low back pain. Diagnoses included disc disease, mechanical back pain, and osteoarthritis. Lumbar lordosis, thoracic kyphosis, head position, shoulder position, shoulder height, pelvic tilt, and leg length were measured using a photographic technique. In standing, chronic pain patients exhibited an increased lumbar lordosis compared with controls (p < .05). Acute patients had an increased thoracic kyphosis and a forward head position compared with controls (p < .05). In sitting, acute patients had an increased thoracic kyphosis compared with controls (p < .05). These postural parameters identified discrete postural profiles but had moderate value as predictors of low back pain. Therefore other unidentified factors are also important in the prediction of low back pain.

Acute Disease↗
PubMed1997

An association between the flat back and postpolio syndromes: a report of three cases.

The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spinal fusion for degenerative disease as adults were reviewed. The flat back syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral fracture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial operative restoration of, lumbar lordosis. Considering the essential role that the trunk extensor musculature plays in maintaining upright posture, it may be that a new onset of weakness (postpolio syndrome) in this musculature represents a major contributing factor to the flat back syndrome in these patients. Spine surgeons considering operative procedures in patients with a remote history of paralytic poliomyelitis should be aware of the possible increased risk of the flat back syndrome in this population of patients.

Back Pain↗
PubMed1988

The aetiology of spinal deformities.

There are two types of spinal deformity, lordosis and kyphosis, and they are mutually exclusive at the same site. Lordosis is rotationally unstable and buckles to the side with growth and spinal flexion, producing scoliosis and changes in transverse plane geometry as secondary phenomena. Kyphosis is a uniplanar deformity arising behind the axis of spinal column rotation and it does not buckle. Spinal balance in the sagittal plane is delicate and in the normal child during adolescence both idiopathic scoliosis and idiopathic kyphosis can easily develop. The development and progression of spinal deformities can be explained in biological and mechanical terms. Any condition in which the critical load to the spine is reduced will favour the production and progression of a spinal deformity. Neuromuscular factors in idiopathic scoliosis are additive and not causative.

Adolescent↗
PubMedDate not supplied

Lateral cervical curve changes in patients receiving chiropractic care after a motor vehicle collision: a retrospective case series.

OBJECTIVE: To examine radiological changes of the lateral cervical curve in patients who received chiropractic care after motor vehicle collisions. DESIGN: A retrospective case series. Thirteen patients who had received chiropractic care after motor vehicle collisions were selected from a northeastern Washington chiropractic office. Patients had a lateral cervical radiograph taken prior to the initiation of chiropractic treatment and a comparative lateral cervical radiograph subsequent to a period of care. Cases were included if they met the previously stated criteria and if the radiographs were of sufficient quality to determine the lateral cervical curve from C2-C7. RESULTS: Adjustments rendered using an Activator Adjusting Instrument. Eleven of the subjects were also instructed to perform stretching exercises. Compared to the initial lateral cervical radiograph, the comparative radiographs demonstrated a mean increase in cervical lordosis between C2 and C7 of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. CONCLUSION: There was a mean increase in the cervical lordosis of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. We were not able to determine the individual effects of adjustment, stretching, and natural progression of the condition. The results suggest that further study of this phenomenon should be undertaken.

Accidents, Traffic↗
PubMed1999

The effect of childhood spinal cord injury on skeletal development: a retrospective study.

STUDY DESIGN: Cross-sectional clinical review. OBJECTIVES: To assess the relationship between late spinal deformity in childhood onset spinal cord injury (SCI) and level of spinal cord lesion, severity of lesion, age at onset, duration of paralysis and pelvic deformities. SETTING: People with spinal cord injury (onset in childhood) treated and followed up at the National Spinal Injuries Center (identified from case notes review, contacted and agreed to participate). METHOD: One hundred and eighty-nine subjects satisfying study inclusion criteria (acute onset SCI before the 16th birthday) were identified by case note review of 8200 records. Eighty formed the group attending for clinical review including whole spine radiographs (AP and lateral). Clinical examination included neurological status and joint range of movements. Demographic data was recorded. RESULTS: Scoliosis occurred more frequently and was more severe in those injured at a younger age, 38 degrees, compared with 24 degrees in those injured later (P<0.05), in paraplegia, 33 degrees, versus tetraplegia, 17 degrees, (P<0.01) and in complete, 36 degrees, versus incomplete lesions, 18 degrees, (P<0.001). Lordosis angulation in paraplegic subjects was significantly greater than in tetraplegic subjects in both seated, 50 degrees versus 25 degrees (P<0.014) and standing subjects 78 degrees versus 59 degrees (P<0.017) respectively and for kyphosis in standing subjects, 52 degrees versus 31 degrees (P<0.01). Sagittal measurements were influenced by habitual posture (which also corresponded to the severity of the lesion). CONCLUSION: Younger age at onset was shown to be associated with more severe scoliosis, as has been reported by others. Subjects with paraplegia and complete lesions demonstrated a greater and more frequently occurring scoliosis than those with tetraplegia and incomplete lesions respectively. Lordosis was greater in those with paraplegia than with tetraplegia and in those with very incomplete lesions compared with complete lesions. However the influence of the severity of the lesion cannot be separated from the postural position when analyzing spinal deformity.

Adolescent↗
PubMedDate not supplied

[The KIL-system for qualitative and quantitative evaluation of posture in lateral view].

AIM: To register also minor variations of posture sa simple and economic procedure should be worked out to categorize posture types concerning quality as well quantity. METHOD: On the Image of the lateral body profile three reference points were determined which allow us to measure two distances and two angles. RESULTS: The relation of the two distances reflects the degree of kyphosis, the angles indicate on the one hand the inclination of the spinal sagittal configuration and on the other hand the degree of lordosis. The measured values are shown in the Kyphosis-Inclination-Lordosis system (KIL system). The components of measurement have proved successful also for static as well as for dynamic posture assessments. The method was simple and economic as postulated. CONCLUSION: The method allowed us to analyse reliably the effect of active primary Intervention also for minor variations in posture on pupils at the age of 11 to 15 over a period of three years. The quantitative analyse made it possible - contrarily to the usual postural types going by what Staffel said - to define subcategories and with it a precise selection of individuals who need a secondary intervention. The method has been set up for check-ups in school, but an application to other groups should be possible.

Anthropometry↗
PubMedDate not supplied

[Lumbosacral fusion using a femoro-cortical allograft ring].

AIM OF THE STUDY: To evaluate the midterm radiographic behaviour of femorocortical allograftrings (FCA) in lumbosacral fusions in patients with disabling low back pain. METHODS: The radiographs of 41 patients with a minimum follow-up of 2 years were analysed by an independent orthopedic radiologist. The fusion rate was determined on lateral tomograms routinely obtained at 3 months intervals. On lateral radiographs the posterior intervertebral disc height as well as the segmental lordosis were measured. Changes of the allografting such as mottling, resorption and incorporation were registered. RESULTS: The fusion rate was 95.2%. Time to radiographic fusion averaged 8.7 months (2-34 months) and in 66.1% radiographic fusion occurred without significant subsidence. In 18.6% fusion with subsidence resulted from resorption of the FCA and in 15.3% the FCA had protruded into the vertebral body. The posterior intervertebral disc height increased postoperatively by 1.9 millimeters on average. However, postoperative height loss was the rule and occurred within the first 12 postoperative months, resulting in a negligible final gain in height of 0.3 millimeters on average. The final gain in segmental lordosis was 1.3 degrees on average. Complete graft incorporation occurred in 16 of 62 segments (25.8%). CONCLUSION: The described technique has proven to be highly effective in achieving a high fusion rate with a stable midterm graft behaviour.

Adult↗