What is lordosis

Lordosis is an excessive inward curvature of the spine that results in a “swayback” appearance that can make the buttocks more prominent appearance. A small degree of lordosis is normal. For example, an increase of lumbar lordosis during pregnancy, especially during the last months is well documented ¹. Furthermore, it has been shown that the degree of lumbar lordosis in women is significantly associated with the number of pregnancies ². Whitcome et al. ³ stated that during pregnancy, women naturally increased their lumbar lordosis in order to retain their relatively stable center of mass, by no more than 1 cm. It is when this curvature becomes excessive that lordosis of the spine can cause problems.

A normal spine, when viewed from behind appears straight. However, a spine affected by lordosis shows evidence of a curvature of the back bones (vertebrae) in the lower back area, which is visible from the side.

Lordosis tends to make the buttocks appear more prominent. Children with hyperlordosis will have a large space underneath the lower back when lying face up on a hard surface.

Some children have marked lordosis, but, most often fixes itself as the child grows. This is called benign juvenile lordosis.

Spondylolisthesis may cause lordosis. In this condition, a bone (vertebra) in the spine slips out of the proper position onto the bone below it. You may be born with this. It can develop after certain sports activities, such as gymnastics. Spondylolisthesis may develop along with arthritis in the spine.

Most of the time, lordosis is not treated if the back is flexible. It is not likely to progress or cause problems.

Lordosis causes

The cause of lordosis has been linked to achondroplasia and spondylolisthesis. However, lordosis may be associated with poor posture, a congenital (present at birth) problem with the vertebrae, neuromuscular problems, back surgery, pelvis, or a hip problem.

Causes lordosis include:

• Neuromuscular conditions e.g., spina bifida, cerebral palsy, muscular dystrophy.
• Congenital problem- something the child is born with.
• Hip or Pelvic conditions
• Previous back surgery
• Poor posture-muscle imbalances
• Athletic activities

Lordosis symptoms

Each person may experience symptoms differently. The major clinical feature of lordosis is a prominence of the buttocks. Symptoms will vary depending if lordosis occurs with other defects, such as muscular dystrophy, developmental dysplasia of the hip, or neuromuscular disorders.

Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with lordosis. A child experiencing these types of symptoms requires immediate medical evaluation by a doctor.

The symptoms of lordosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your doctor for a diagnosis.

• The major clinical feature of lordosis is a prominence of the buttocks.
• Typically painless
• Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with lordosis. If you’re experiencing these types of symptoms requires further medical evaluation by a physician is needed.

Lordosis diagnosis

The doctor makes the diagnosis of lordosis with a complete medical history, physical examination, and diagnostic tests. Your doctor will ask if other family members are known to have lordosis.

Other tests may be needed, particularly if the lordosis seems “fixed” (not bendable). These may include:

• X-rays. This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine X-ray, the doctor or radiologist measures the angle of the spinal curve. A determination for treatment can often be made based on this measurement.
• Bone scans. Bone scans are a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures.
• Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
• Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Blood tests

Early detection of lordosis is important for successful treatment. Pediatricians or family doctors, and even some school programs, routinely look for signs that lordosis may be present.

Lordosis treatment

Specific treatment for lordosis will be determined by your doctor based on:

• Your age, overall health, and medical history
• The underlying cause of the lordosis
• The extent of the condition
• Your child’s tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

The goal of treatment is to stop the progression of the curve and minimize deformity. Management of lordosis will depend on the cause of the lordosis. Simple exercises may be sufficient if lordosis is associated with poor posture. However, lordosis occurring as a result of a hip problem may be treated as a part of the hip problem.

• Observation: Keeping watch on curves – Once an abnormal spine curve has been detected, it is important to monitor the curve. In many cases, a
  child’s spinal condition may only require close monitoring during skeletal growth. Your physician will decide on your treatment plan and follow-up
  based upon your X-rays and physical exam.
• Physical Therapy: With the goal of maximizing physical function, physical therapists work closely with you to provide exercise programs and additional physical therapy modalities to address pain and muscular imbalance often associated with spinal abnormalities.
• Bracing: If your curve shows significant worsening or is already greater than 30 degrees, and you are still growing, your physician may recommend a bracing program.
• Surgery is only required in the most severe cases of lordosis.

Lordosis long-term outlook

The management of lordosis is individualized for each person depending on his or her age, amount of curvature, and amount of skeletal growth remaining. Lordosis will require frequent examinations by your doctor to monitor the curve especially in children as the child grows and develops. Early detection is important.

References

1. Masharawi Y, Dar G, Peleg S, Steinberg N, Medlej B, May H, et al. A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females. Eur Spine J. 2010; 19: 768–773. doi: 10.1007/s00586-009-1256-6
2. Letafatkar K, Hadadnezhad M, Arashpour H, Heris MB. Effects of weight, gender and number of pregnancies on lumbar total and segmental lordosis and low back pain. J Res Rehab Sci. North America. 2010; 4
3. Whitcome K, Shapiro L, Lieberman D. Fetal load and the evolution of lumbar lordosis in bipedal hominins. Nature. 2007; 450: 1075–1078