Lumbar lordosis

High lordosis lumbar lordotic curve passes into thoracic region, including half to two-thirds of thoracic spine in anterior convex-... 

Protuberant abdomen with exaggerated lumbar lordosis, usually an asthenic appearance with rather long extremities and tapered fingers, and frequently a barrel-shaped chest... 

Children experience delayed growth and sexual maturation, and characteristic physical findings such as protuberant abdomen and exaggerated lumbar lordosis. 

Evolution— rapid and relentlessly progressive symmetrical weakness of thigh and pelvic girdle muscles (tendency to fall, diflSculty in rising, rolling gait, lumbar lordosis) and soon of muscles of shoulder girdle, trunk, and upper limbs 80% of cases show initial pseudohypertrophy of muscles, notably the calves, due possibly to fatty replacement (P7b). 

A 2-year-old girl with a past history of asthma, developmental delay, short neck, and lumbar lordosis, but no known genetic defect or syndrome underwent anesthesia with midazolam and paracetamol premedication, halothane and nitrous oxide induction, and isoflurane plus nitrous oxide for maintenance of anesthesia. Difficulty with mouth opening was noted and endotracheal intubation was difficult. Limb rigidity developed rapidly. Thiopental and cisatracurium were given and the muscle rigidity abated over the next 10 minutes. 

Assessment of Trunk Posture An asymmetric trunk posture should be avoided (no trunk axial rotation or trunk lateral flexion). Absence of normal lumbar spine lordosis should be avoided. If the trank is inclined backward, full support of the lower and upper back should be provided. The forward trunk inclination should be less than 60°, on the condition that the holding time be less than the maximum acceptable holding time for the actual forward trunk inclination, as well as that adequate rest is provided after action (muscle fitness should not be below 80%). 

Fig. 2. The X-ray parameters thoracic kyphosis, lumbar lordosis and sagittal tilting of T9 (this parameter replaces GFFP In the chain of correlations)...

Spinal Parameters. The thoracic kyphosis and lumbar lordosis angles the sagittal tilting of T9 (angle between the vertical and the axis running through the femoral axis and the center of T9, Fig. 2). 

The pelvic parameters and the lumbar lordosis (only for 30 of them) were recorded, and also an angular measure of the forward sliding of L5. This angle was defined by J. Hecquet. It is the angle between the Une running through the middle of the two adjacent vertebral plates with the bis-sector of the dihedral angle (Fig. 7). 

Psoas This muscle is attached to the vertebral body at a point opposite the center of rotation of the vertebra, so it is attached to the base of the pedicle and the anterior surface of the transverse process. It is inserted at the lesser trochanter of the femur and alters lordosis of the lumbar spine. Hip flexion contractures permit shortening of the psoas, which increases lordosis. Further contracture of the muscle has a tendency to pull the mid-lumbar spine forward and inferiorly. 

H. von Meyer described posture in three fashions Normal , relaxed and military . The differences were in the positions of the upper body in relationship to the vertical plane. However, it should be remembered that this analysis occurred prior to the utilization of X-rays. It is hard to judge posture in geometrical terms as you change the inclination of the spinal load line. If the pelvic inclination is decreased by flattening the lumbar lordosis, the spinal load line shifts anteriorly. If the lumbar lordosis is increased, the pelvic inclination is increased, and this causes the hip joints to assume a flexed position, permitting relaxation and protrusion of the abdominal wall. Therefore, analysis of only the sagittal contour ignores the inclination of the pelvis and its influence on the spinal load line. 

Lordosis influenced the depth of engagement of the facet joints, which would determine how much torque could be applied to the pelvis. An example of this is that, when you walk with a large, cumbersome box in front of you, the lumbar spine adopts a flexed posture because of the size of the load in your arms. This, therefore, only allows a minimal amount of facet joint engagement, producing a very slow gait velocity. 

Distraction increases lumbo-sacral kyphosis and decompensation with loss of lumbar lordosis. The higher the lumbar fixation, the worse the effect on sagittal alignment. 

In the first group of adolescent patients (mean age 14.5), translation was reduced from 78% to 15%, RS angle from 30° of kyphosis to 3° of lordosis, and lumbar lordosis reduced spontaneously from 73° to 50°. 

Posterior distraction instrumentation as a reduction force was first used in the 1970s as a technique to provide a partial reduction and stabilization to enhance the spinal fusion. These early reports appeared to provide a satisfactory alternative to fusion in situ [4]. However, it soon became apparent that loss of lumbar lordosis was an invariable outcome of this technique, and in fact the results were often worse than the patient s original problem and complaint [7]. 

The understanding of the relationship static spine - position of the pelvic/ sacrum and position of the femoral heads - can best be derived from a Bech-terew kyphosis - pre- and postoperatively. In addition to the flattened lumbar lordosis and thoracic kyphosis, the preoperative picture shows clear retrover-... 

Fig. 3. Behavior of the positional and spinal parameters in a 9-year old child with dysplastic spondylolisthesis tremendous changes of the positional parameters, but also of the entire spinal parameters with flattening of the lumbar lordosis and the thoracic kyphosis, including displacement of the gravityline anterior to the center of the femoral head...

The changes which occur during the development of spondyloptosis in both the local and regional areas must inevitably have an implication on the entire sagittal profile, otherwise the balance of the body over the center of the femoral heads would not be possible. With respect to the above, the lumbar lordosis measured between LI and L5 and the thoracic kyphosis measured between T4 and T12 is of special importance (Fig. 7 d). 

The pelvic position-dependent parameters show a sacro-femoral tilting of 45°, the overhang is 68 mm. Spinal parameters the lumbar lordosis measured between T12 and L5 is 62°, the thoracic kyphosis measured between T2 and T12 is 12°. The sagittal tilting shows an anteriorly directed element. The gravity line (measured from C7) lies anterior to the center of the femoral heads. 

---