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Lordotic deformities

Lordosis is a disorder defined by an excessive inward curve of the spine. It differs from the spine's normal curves at the cervical, thoracic, and lumbar regions, which are, to a degree, either kyphotic or lordotic. The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.

Lordosis can be found in all age groups. It primarily affects the lumbar spine, but does occur in the neck (cervical). When found in the lumbar spine, the patient may appear swayback, the buttocks more prominent, and in general an exaggerated posture. A lumbar lordosis can be painful sometimes affecting movement.

Certain disease processes can adversely affect the structural integrity of the spine and contribute to lordosis. Some common causes include achondroplasia, discitis, kyphosis, obesity, osteoporosis, and spondylolisthesis.

Causes

• Achondroplasia is an inherited bone growth disorder that may cause a type of dwarfism.
• Discitis is inflammation of intervertebral disc space.
• Kyphosis (e.g. humpback) may force the low back to compensate for the imbalance created by a curve occurring at a higher level of the spine (e.g. thoracic).
• Obesity may cause some overweight people to lean backward to improve balance. This has a negative impact on posture.
• Osteoporosis is a bone density disease that may cause vertebrae to loose strength compromising the spine's structural integrity.
• Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.
• Neuromuscular Lordosis associated with neuromyopathy or myopathy.

Diagnosis

A thorough physical examination reveals a lot about the health and general fitness of the patient. The physician will want to know when the curvature was first noticed, past progression, and other related symptoms the patient experiences. The exam provides a baseline from which the physician can measure the patient's progress during treatment. The physical exam may include:

1. Palpation determines spinal abnormalities by feel.
2. Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation. Asymmetry is also noted.

Neurologic Evaluation

Radiographic

The patient stands to reveal the entire length of the spine when PA (posterior/anterior, or back and front) and Lateral (side) x-rays are taken. Side bending AP x-rays are sometimes used to evaluate spinal flexibility. An MRI may be ordered if the spinal cord has been compromised (or suspected).

Further, the Cobb Angle Method may be used to measure the lordotic curve in degrees using a standard full-length AP x-ray.

Conservative treatment measures may include:

1. Analgesics and anti-inflammatory medication.
2. Physical therapy enabling the patient to build strength, flexibility, and increase range of motion. The therapist may provide a customized home exercise program.
3. Bracing may be used control curve progression in adolescents.
4. Reduction of body weight to ideal.
5. Surgery may be considered if the lordotic curve is severe.

Surgery

Surgical intervention is considered if the lordotic curve is severe, when neurologic involvement exists, or conservative treatment has failed to provide relief.

A spine surgeon decides which surgical procedure and approach (anterior/posterior, front or back) is best for the patient. His decisions are based on the patient's medical history, symptoms, and radiographic findings.

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