Lordosis

General Information


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Description

Lordosis is an increased curving of the spine.

Considerations

The spine has three types of curves:

  • Kyphotic curves refer to the outward curve of the thoracic spine (at the level of the ribs).
  • Lordotic curves refer to the inward curve of the lumbar spine (just above the buttocks).
  • Scoliotic curving is a sideways curvature of the spine and is always abnormal.
In the lumbar spine, lordosis is commonly defined by the angle between the upper plane of L1 and the upper plane of S1. Lumbar lordosis angles are the following:
Hyperlordosis: > 70°
Normal lordosisl: 31°-50°
Hypolordosis: 11°-30°
Lumbar kyphosis: < 10°

A small degree of both kyphotic and lordotic curvature is normal. A large kyphotic curvature causes round shoulders or hunched shoulders (Scheuermann’s disease).

Presentation/Signs and Symptoms

General symptoms

  • Postural deformity
    • Neck and back pain, generally increased with prolonged sitting/standing
    • There may be radicular symptoms
    • Headaches
    • Functional limitation in more severe cases
  • Frequently observed postural abnormalities
    • Forward head posture
    • Head anterior to shoulders
    • Middle cervical spine extended
    • Lower cervical segments flexed
  • Kyphosis-lordosis posture
    • Anterior pelvic tilt
    • Exaggerated lumbar lordosis
    • Mild hip flexion
  • Flat back posture
    • Flexion of upper thoracic segments
    • Posterior pelvic tilt
    • Diminished lumbosacral angle
  • Sway back posture
    • Forward head
    • Increased flexion of upper thoracic segments
    • Posterior shift of upper thoracic region
    • Entire pelvis shifted anteriorly
    • Hips pushed into extension

Too much lordotic curving is called swayback. Lordosis tends to make the buttocks appear more prominent. Children with significant lordosis will have a significant space beneath their lower back when lying on their back on a hard surface.

If the lordotic curve is flexible (when the child bends forward the curve reverses itself), it is generally not a concern. If the curve does not move, medical evaluation and treatment are needed.

Causes

  • Achondroplasia
  • Benign juvenile lordotic curve (not medically significant)
  • Spondylolisthesis