Lordosis is a physiological or pathological bending of the spine, in which its bulge is turned anteriorly. Physiological lordosis is observed in all people in the lumbar and cervical spine. Pathological lordosis is usually located in the same departments, but differs from the physiological degree of bending. In rare cases, pathological lordosis is formed in the thoracic spine. It is manifested by a violation of posture and back pain. It is diagnosed on the basis of examination data and radiography results. Treatment can be both conservative and operative.
Lordoz (from Greek. lordos - bent, stooped) is a physiological or pathological curvature of the spine in the antero-posterior direction with a bulge facing anteriorly. Physiological lordosis is normally formed in the first year of life. Pathological lordosis can develop at any age due to congenital or acquired pathology of the vertebrae, hip joints, back muscles, buttocks and thighs. Accompanied by pain and impaired posture. In severe cases, it can complicate the work of internal organs. Treatment of lordosis is more often conservative. With severe pathology and/or progression of pathological lordosis, surgery may be required.
The cause of the development of primary pathological curvature can be processes such as malformations, tumors and inflammation in the vertebral region, spondylolisthesis, muscle torsion spasms and spinal injuries.
Secondary pathological lordosis can occur due to flexion contracture of the hip joint, ankylosis (immobility) of the hip joint, pathological or congenital dislocation of the hip, systemic diseases of the musculoskeletal system, cerebral spastic paresis of the lower extremities, polio with damage to the muscles of the pelvic region and lower extremities, as well as pregnancy. In the latter case, lordosis is temporary and disappears after the birth of the child. With all these conditions, the center of gravity of the body shifts forward and, in order to maintain balance, the person bends in the lower back.
Among the predisposing factors that increase the likelihood of developing lordosis and, under certain conditions, can cause this pathology, also includes a violation of posture, overweight with the deposition of a large amount of fat on the abdomen and sharp growth in childhood and adolescence.
In children and adolescents, secondary compensatory hyperlordosis is usually mobile in nature and may decrease or disappear when the cause that caused it is eliminated. The long-existing lordosis in adult patients becomes fixed, and the bending of the spine in such cases does not change even after the elimination of provoking factors.
Normally, the human spine has 4 curvatures: two lordoses (lumbar and cervical) and two kyphoses (sacral and thoracic). All of them are located in the anteroposterior (sagittal) direction. Lateral curvature (scoliosis) should not be normal.
The first signs of physiological kyphoses and lordoses are detected immediately after birth. However, they are poorly expressed in infants. The curves become pronounced when the child begins to stand and walk, that is, by the end of the first year of life. And finally the anatomical structure of the spine is formed by the age of 16-18, when the bone growth zones are closed. Nevertheless, pathological lordosis can occur in both children and adolescents, as well as in adults. The reason for its development in various cases is a change in the shape and size of the vertebrae, as well as other pathological processes in some parts of the musculoskeletal system.
In pathological lordosis, a number of characteristic changes are usually observed. The vertebrae shift anteriorly, their bodies fan out. In the anterior sections, there is a rarefaction of the bone structure and expansion of the intervertebral discs. Spinous processes adjacent to the affected vertebrae are compacted and converge. If pathological lordosis occurs in childhood or at a young age, a deformity of the chest develops, accompanied by compression and a violation of the function of the organs of the thoracic cavity. Deformations of other parts of the body may also be observed. At the same time, the earlier lordosis appeared, the more pronounced the listed changes are.
In traumatology and orthopedics, lordosis is classified according to several characteristics.
Taking into account localization:
Taking into account the causes of occurrence:
Taking into account the form:
Taking into account the possibility of returning the body to its normal position:
Common manifestations include a change in posture (usually when the normal curvature of one part of the spine is violated, there is a more or less pronounced curvature of its other parts), increased fatigue and pain in the affected spine, which increase after physical exertion or being in an uncomfortable position. There is a limitation when performing certain physical actions. With severe lordosis, diseases of the heart, lungs, kidneys, stomach and intestines may develop due to a violation of the normal disposition and compression of the corresponding organs.
Depending on the nature of the pathological changes, there may be several variants of posture disorders, accompanied by a decrease or increase in lordosis.
A round-bent back (kifolordotic posture) is accompanied by an increase in all bends. Lumbar lordosis and thoracic kyphosis are enhanced. The legs are in a position of slight overextension or slight flexion at the knee joints. The shoulder blades stick out, the shoulders are brought, the upper arms are raised, the stomach protrudes forward. The head can also be slightly pushed forward.
Round back (kyphotic posture). There is a significant increase in thoracic kyphosis with a corresponding decrease in lumbar lordosis. The center of body mass with such a violation of posture shifts posteriorly, so a person slightly bends his legs when standing and walking to even out this imbalance. There is a forward tilt of the head and a decrease in the angle of inclination of the pelvis. The shoulders are given, the upper arms are raised, the shoulder blades stick out. The arms hang somewhat anteriorly from the torso. The chest is sunken, the stomach protrudes forward.
Flat-bent back. There is a flattening of the cervical lordosis and a decrease in thoracic kyphosis. Lumbar lordosis is normal or enlarged. The pelvis with this posture, the center of mass shifts posteriorly, the knees are bent or slightly bent. The head is lowered, the chin "looks" down. The shoulder blades stick out, the chest is sunken.
Flat back. All the natural curves of the spine are reduced, especially pronounced flattening of lumbar lordosis. The angle of inclination of the pelvis is reduced. The shoulder blades stick out, the chest is shifted anteriorly, the lower part of the abdomen protrudes.
Most often, when talking about pathological lordosis, they mean an increase in lumbar lordosis (lumbar hyperlordosis), in which kypholordotic posture is observed. It is this change in the shape of the spine that develops in most secondary pathological lordoses.
Taking into account the nature of the pathological process, several types of hyperlordosis are distinguished, which differ in symptoms and clinical course.
Fixed and non-fixed lumbar enhanced lordosis, which develops as a result of processes that cause the displacement of the center of gravity of the body anteriorly. It can occur when the chest is deformed due to spondylolisthesis, posterior dislocation and flexor contracture of the hip, as well as a sharp curvature of the spine with the formation of a rib hump as a result of severe scoliosis or bone tuberculosis. The onset can be both acute and gradual. The nature of the course and clinical symptoms are determined by the degree of lordosis.
Extensor lumbar-hip rigidity. It develops in young patients with a normal spine condition. It is formed as a protective pose for various volumetric and adhesive processes in the area of nerve roots. It can occur with arachnoiditis of the spinal cord, sciatica and some other diseases. Excessive lordosis in this case appears due to pain-free contracture of the lumbar and gluteal muscles. The beginning is gradual. A characteristic feature of such lordosis is a sliding gait. Usually proceeds favorably.
Fixed lumbar enhanced lordosis, which occurs due to volumetric processes in the lumbar spine. Most often, such lordosis develops with herniated discs. Usually, the first symptoms of lordosis appear in middle age. The onset can be either gradual or acute (with a breakthrough of the gelatinous nucleus). Lordosis is accompanied by extensor contracture of the lumbar and gluteal muscles. When trying to overcome contracture and give the body a normal position, there is a sharp pain in the hip joints. There are symptoms of stretching. Irradiation (the spread of pain along the back of the thigh and lower leg) is rarely noted. There are no violations of sensitivity and movements. The course of lordosis is usually unfavorable. Decompensation develops over time, neurodystrophic changes in soft tissues occur. Pronounced, prolonged pain is characteristic.
Due to the violation of the normal shape of the spine in all types of lordosis, there is a pathological redistribution of the load on bones, ligaments and muscles. The ligaments are overgrown, the muscles are constantly in a state of increased tension. As a result, lethargy, weakness, and fatigue develop. With persistent, long-existing lordosis, the following complications may occur:
The diagnosis of pathological lordosis is made on the basis of examination and radiography data. During the examination, the doctor evaluates the patient's natural body position and posture features, and also conducts a number of special tests to determine whether lordosis is fixed and whether it is accompanied by neurological disorders. In addition, the doctor palpates the back muscles and examines the organs of the thoracic cavity.
If a pathological lordosis is suspected, an X-ray of the spine in a straight and lateral projection is mandatory. In order to get an idea of the degree of lordosis, lateral radiographs are performed with maximum extension and flexion of the back. At the same time, the radiologist evaluates the mobility of the spine in the anterior-posterior plane (normal, reduced, enhanced) by measurements. In addition, the doctor identifies violations of the structure and shape of the vertebrae, as well as their mutual disposition.
Orthopedists and vertebrologists are engaged in the treatment of pathology. The main task of therapy is to eliminate the cause that caused the pathological lordosis. During the treatment, kinesitherapy rehabilitation and orthopedic procedures are also carried out. Patients are prescribed manual therapy, therapeutic massage and physical therapy. Sometimes wearing posture correctors (bandages or corsets) is shown. With primary pathological lordoses, surgical treatment is carried out with subsequent rehabilitation.