What is Lordosis?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Lordosis, or lumbar lordosis, is an inward curving or the lower area of the spine. Although mild lordosis is considered to be normal, a more extreme curve can create problems that need evaluation and treatment by a physician or qualified natural health practitioner. Lordosis is commonly caused when a vertebra in your spine slips out of place (spondylolisthesis). Physical exertion and sports like gymnastics and medical conditions such as muscular dystrophy can also be the cause of or exacerbate lordosis, causing varying degrees of lordosis back pain.

This inward curving of the lumbar region of the back is often detected in children. It can give them an exaggerated “C” or “S” shape of the spine, making the buttocks more prominent than normal. This condition is commonly called “swayback” appearance. Spine specialists and researchers are not always in agreement on what a “normal” spinal curve is or the most accurate test procedure for determining the extent of the curve. Although the range of spinal curves that are generally accepted as indicating lumbar lordosis is from 39 to 53 degrees, these angles can vary greatly among patients.

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More About Lordosis

lumbar foraminotomyMany different factors can affect what would be considered your normal lumbar angle measurement. Your age, ethnicity, gender and whether or not you play sports or engage in regular physical activity or exercise can all contribute to your correct normal angle. This measurement is also affected by your body mass index, or your height to weight ratio. Whether you are of average weight, underweight, overweight, or obese can all affect the measurement of your normal lumbar angle. The degree of strength and flexibility of your muscular structure also plays a part in determining your correct angle.

If, when you lie on your back on a flat surface, there is a space between the lumbar (lower) region of your spine and the surface you are lying on, this indicates that you have some degree of lumbar lordosis. If, when you stand and bend forward, this curve disappears as your back arches, your lordosis is most likely within your normal lumbar angle. However, if you are experiencing any back pain, numbness, tingling or stiffness, a medical doctor who is a specialist in treating spinal conditions and disorders should examine you.

Especially in young children, lordosis can improve, since the lumbar angle can change as youngsters grow. Children with pronounced lumbar lordosis, however, should be examined while still small by a spine doctor. A child who is evaluated early in life for this back condition can benefit from treatment as a youngster if needed. If immediate treatment is not needed, the child can be reexamined periodically to determine if any treatment measure is recommended as he or she grows and the spine develops. Even by early teenage years, children’s spines can strengthen, straighten and conform to acceptable lumbar angles.

Lordosis Symptoms

Lordosis symptoms and lordosis back pain can vary somewhat among patients and also according to the degree of severity of the lumbar angle that determines the diagnosis of this lower back condition. Common symptoms include the following:

  • Back Spasms. – Back spasms can occur with this condition and may be mild or pronounced. Although these spasms can move to different areas of the back, they usually originate and are focused mainly in the lower back, or lumbar region. They can also initiate in the neck and lumbar area simultaneously. Starting often as a tightening sensation, this muscular cramping can become severe and last for an indefinite time period. However, in most patients, back spams often begin and subside rather quickly and without any other prior symptoms.
  • Tightness in the Lower Back. – The lumbar region of your back may tighten and feel stiff and inflexible, sometimes suddenly. In patients with mild lordosis, this tight, uncomfortable sensation may last only briefly. In patients who are undergoing physical therapy for their back conditions, manipulation of the spine, starting in and focusing on the lumbar region, may help the tightness to lessen and subside. However, in many patients, frequent occurrences of this tightness are fairly common, with some occurrences lasting much longer than others.
  • Lack of Mobility in the Neck or Lower Back. – Patients may experience a lack of mobility, especially in the neck and lower back when diagnosed with lordosis. This stiffness can be more pronounced when he or she first awakens in the morning and also at night following a long and eventful or stressful day.
  • Numbness or Tingling in the Back. – Some patients experience numbness or tingling sensations in the back, which usually occur intermittently. These sensations can also precede the occurrence of spasms or pains affecting mainly the lumbar area of the spine.
  • Pain Focused in the Lower Back. – Many lordosis patients experience lordosis back pain that is focused in the lower back and may spread to other areas of the spine. These pains can be shooting and sharp, or aching pains that continue for longer periods of time.
  • Loss of Bladder Control. – Some patients may also experience loss of bladder control at times, although this symptoms may be temporary and can respond well to treatment.

How is Lordosis Diagnosed?

When diagnosing lordosis, a physician will make a record of the patient’s medical history and then perform a thorough physical examination. This will enable the doctor to determine better when the patient first experienced an increase in the lumbar angle and whether or not the condition has since worsened or changed. During the exam, the patient’s extent of back and limb mobility and flexibility will also be evaluated, and the physician will check the patient’s back alignment.

The doctor may also arrange a neurological assessment if the patient is experiencing symptoms of pain, numbness, muscle spasms, tingling or weakness in the back, arms or legs. X-rays will also usually be made of the patient’s back, and any changes in his or her bladder and bowel control will be tested and evaluated as well. During the examination, the physician will also determine the patient’s lumbar curve angle to help in determining the severity of the curve and how best to treat the condition.

The measurement of the lumbar angle will also help the doctor decide on how best treat the patient’s symptoms and restore flexibility and more relaxed muscular motion to the back while reducing or alleviating lordosis back pain. This lumbar angle movement is also helpful to the doctor in gaining insight on the time of onset of lordosis for any patients who do not have an obtainable medical history that includes prior diagnosis and treatment methods for this condition that the patient may have received as a child, teenager or younger adult.

What Are the Causes of Lordosis?

low back pain

Lordosis can be caused by different factors. Spondylolisthesis, a condition in which a vertebrae slips out of place, is a frequent cause of lordosis. This inward curve of the lumbar region of the spine can also be a result of other medical conditions such as muscular dystrophy. Some individuals also develop lumbar lordosis from participation in strenuous physical activities like gymnastics and acrobatics. Individuals who are obese or have been diagnosed with discitis (inflammation between the intervertebral discs of the spine) or kyphosis (an outward curve of the upper spine) may also develop lordosis.

This lower back inward curvature can also be congenital, and it can be very helpful to later treatment if a child born with this condition gets an early diagnosis. Lordosis may also be caused by such neuromuscular conditions as spina bifida (a defect in the neural tube that causes abnormalities of the spinal cord and spine) and cerebral palsy. Other health problems that can contribute to the development or worsening of lordosis are hip or back conditions, back injuries, muscular imbalances in the back and poor posture.

How is Lordosis Treated?

Treatment and procedure options for Lordosis range from conservative options like injections to more intensive procedures like spinal fusions.

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. In the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Lordosis

Lordosis is usually diagnosed according to the results of patient X-rays, an MRI or CT as well as bone scans in some cases. These advanced imaging machines are typically available in diagnostic testing centers and hospitals for physicians’ diagnostic evaluations of patients.

Physicians also usually determine the lumbar curvature’s Cobb angle, calculated from interpretation of the patient’s spinal X-ray. The angle will reveal the severity of the patient’s Lordosis and helps the doctor decide on the proper treatment for this condition. With use of centroid, tangential radiologic assessment of a patient’s lumbar lordosis can also be accomplished (THRALL). Some spine doctors also use the Harrison posterior tangent line-drawing form of assessment of this condition.

How Does Lordosis Compare to Other Spine Conditions?

The three primary types of spine curvature disorders are lordosis, kyphosis, and scoliosis:

  • Lordosis – Lordosis, or the swayback inner curvature of the spine, is in the lumbar region of your lower back. Although some degree of inner curve, or lumbar angle, is common in everyone, if this curve becomes extreme, it needs medical attention. Many children have some degree of lordosis, and it often is not diagnosed or treated since many parents assume that children’s backs will straighten as they grow.
    However, although some children do experience lessening of the lumbar inward curve as they grow into their teenage years, many do not. Early detection and observation or treatment of lordosis in children can prevent the worsening of this condition or the development of other back health problems later in life. Although this condition may not be painful in children or young adults, it can lead to further misalignment of the back, which may cause severe or chronic pain, stiffness or numbing sensations.
  • Kyphosis – This back condition occurs when the upper back becomes abnormally curved outward at an angle of more than 50 degrees. This may occur more in mid-aged adults and seniors, but it can occur at any age. This condition, if it worsens, can cause overall back pain, stiffness, and tingling sensations, and it can cause serious misalignment of the back, which can cause falls and injuries, especially in older patients. Visually, kyphosis is the opposite of lordosis, with the outward curve in the upper region of the spine.
  • Scoliosis – Patients with this back condition have a sideways curvature in their spines, which is usually either C-shaped or S-shaped. In this condition, the angle and the placement of the scoliosis can shift, so that it is more obvious on some days than others. The curvature can also change position somewhat and, unless it is severe and requires surgery, scoliosis is often best treated with physical therapy and use of a customized back brace.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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