Lordosis is a curvature of the spine , with a bulge facing anteriorly. Moderate lordosis of the cervical and lumbar spine is physiological; occurs in the first year of life when the child’s static changes. Normally, the apex of the cervical lordosis is located at the level of the V - VI cervical vertebrae, the lumbar - at the level of the III - VI lumbar vertebrae. Pathological lordosis is congenital and acquired, often in combination with other curvatures. Hyperlordosis - pathological deepening of lordosis - occurs when spondylolisthesis (displacement of the vertebra anteriorly - usually V lumbar), bilateral dislocation of the hip, various contractures (Fig. 1), Kashina - Beck rickets disease (Fig. 2), during pregnancy; cervical hyperlordosis can be caused by scars after burns. Hyperlordosis is not fixed, partially or completely fixed. In case of hyperlordosis, the vertebral bodies are displaced anteriorly, diverging fanlikely, and the spinous processes come together, compacted; intervertebral discs are disfigured. Clinic: deformity, poor posture, pain due to compression of nerve roots, restriction of movements.
Fig. 1. Pathological lordosis with hip flexion contracture.
Fig. 2. Hyperlordosis with rickets
Treatment: elimination of the main suffering, exercise therapy , massage , thermal procedures; unloading of the spine, rational laying of the patient on the back, on the side with bent legs, prosthetics with a corset.Go
Lordosis (Greek: lordosis) is a curvature of the spine, with a bulge facing anteriorly. The lordosis of the cervical and lumbar spine (moderately pronounced) is physiological (Fig. 1); it arises in the post-embryonic life of a person due to new static conditions, when the child begins to sit and then walk. Cervical physiological lordosis captures all cervical and two upper thoracic vertebrae; the top of the curvature is located at the CV-VI level. Lumbar lordosis forms DXI — XII and all lumbar vertebrae; its top is projected between LIII-IV.
Pathological lordosis can be congenital and much less frequently acquired. The latter occurs mainly in combination with other spinal deformities. The most common is excessive lordosis (hyperlordosis) of the lumbosacral spine, compensating for the kyphotic curvature of the upper and lower divisions (Fig. 5-8).
Fig. 1. The development of physiological curvatures of the spine in humans: 1 - general spinal kyphosis in a newborn; 2 - development of cervical lordosis; 3 - development of lumbar lordosis.
Fig. 2-8. Compensated lumbar lordosis: rice. 2 - with posterior dislocation of the hip; rice 3 - for tuberculous contracture of the hip joint; rice 4 - with infectious ankylosis of the hip joints in the position of flexion of the thigh; rice 5 - in a rickety child; rice 6 - with a pronounced rachitic thoracic kyphosis; rice 7 - with osteochondropathy of the spine (Scheuermann's disease); rice 8 - in case of Kashin-Beck disease (“family” deformity).
Lumbar hyperlordosis (Fig. 2-4) of static origin is usually formed during spondylolisthesis, with bilateral hip joint dislocation, contractures or ankylosis due to dysplasia, tuberculous or nonspecific coxitis. The mechanism of formation of hyperlordosis is determined by the displacement of the center of gravity of the body posteriorly; the greater the deviation of the center of gravity, the more the lordosis deepens.Go
In the cervical spine, pathological lordosis may occur as a result of Cicatricial contractions (for example, after a burn of the posterior, nuchal, neck region).
Morphological changes in pathological lordosis usually consist in anterior displacement and fan-shaped divergence of the vertebral bodies, a wedge-shaped expansion of the intervertebral discs in the anterior section and a rarefaction of the bone structure. Spinous processes of vertebrae in the departments adjacent to the deformed, on the contrary, are compacted and come together. Phenomena such as osteoarthrosis of intervertebral joints are common; lordosis lying, flattened, but may become fixed.
The clinical picture in pathological lordosis consists of deformity, pain, and restriction of movement (only active - with compensatory non-fixed forms and active and passive - with fixed hyperlordosis). The presence of lordosis causes the appearance of other deformities of the body; so, the younger the patient is, the more the chest and the organs of the chest cavity, whose function is highly impaired, undergo secondary deformation; static deformations may also occur in other parts of the body.
Treatment of hyperlordosis should consist primarily in the radical elimination of the underlying disease, after which the lordosis completely or almost completely normalizes. For pain, analgesics, various thermal procedures, therapeutic exercises, unloading and balneotherapy, sometimes wearing corsets, bandages are shown.
Radiodiagnosis . The correct idea of the degrees of pathological curvature of the spine in the cervical and lumbar parts of the spine can be obtained by studying the lateral radiographs of the spine with its maximum flexion and extension. This determines the mobility of the spine in the sagittal plane (normal, enhanced and reduced). There is no exact determination of the degree of this mobility, but it is quite possible to establish differences in its extreme and intermediate degrees by measurements on radiographs in the side projection.
Accurate measurements may be necessary only for some special purposes. In practical X-ray diagnostics, it is important to use data from a conventional X-ray of the spine in frontal and lateral projections. With enhanced lordosis of the lumbar spine as a result of many years of close position of the spinous processes (under the influence of different conditions - congenital dislocation, spondylolisthesis, obesity, etc.), anomalous joints (neoarthrosis) are formed between them, in which phenomena and deforming osteoarthrosis can develop (rice . 9 and 10).
Fig. 9. Neoarthrosis between the spinous processes of the IV and V lumbar vertebrae (indicated by an arrow): 1 - in lateral projection; 2 - in a direct projection.
Fig. 10. Deforming osteoarthritis in the newly formed articulation between the spinous processes of the III and IV lumbar vertebrae (indicated by the arrow).
On the other hand, a sharp decrease in natural lordosis, or even its complete absence, is an objective symptom of increased muscle contraction due to painful sensations with a completely unchanged state of the spinal bone apparatus itself.
It is necessary to take into account the presence of intensely expressed lordosis in some people, which is important when performing radiographs in direct projection. For the best in such cases, the image of the lower cervical and fifth lumbar vertebrae and intervertebral spaces in a direct projection, it is necessary to give direction to the central beam from the legs to the head (caudo-cranial direction) with its deviation from the perpendicular within 10-20 °. For the upper lumbar vertebrae with enhanced lordosis, it is necessary to direct the central ray in the opposite direction (cranio-caudal), that is, from the head to the legs.