Lordosis can affect the young and the old. It occurs for different reasons and can affect each patient differently.
What is Lordosis?
Lordosis is the natural curve of the lower back (lumbar) area of the spine. With an extreme curve, the lower spine will have a deep curve, causing the abdomen (stomach area) to stick out and causing the pelvis (hip areas) to curve back and up. These extreme curves can be brought on from bad posture, family genetics (passed from father or mother), injury, illnesses of the spine, or surgery to the spine
Types of Lordosis
There are 5 primary types of lordosis:
1. Postural Lordosis
This often comes from being over-weight and lack of muscle conditioning in the stomach and back muscles. When a person carries too much weight in the front (stomach area) it pulls the back forward. When the stomach and back muscles are weak, they cannot support the spine and the pull from the weight causes the spine to curve forward.
2. Congenital / Traumatic Lordosis
A trauma / injury to the connecting links of the spine (pars) can cause them to break (fracture) causing pain in the low spine. In children these often occur from sports injuries. This can also be seen in children hit by a car or with falls from high areas.
There can also be a defect in the way these links develop with growth, causing them to be misshaped and weak. With repetitive activities stressing this weak links, they can develop a spondylolysis (break in bone connection).
Whatever the reason the break occurs it needs rest and restricted movement to heal. If not, over time, the vertebrae (spine blocks) can slip forward and pinch nerves in the spine. This can lead to pain, numbness, tingling, weakness, and dysfunction of the legs.
3. Post-surgical Laminectomy Hyperlordosis
A laminectomy is a surgical procedure where parts of the vertebrae (spinal bones) are removed to give access to the spinal cord or nerve roots. When this is done over several levels in the spine, it can cause the spine to be unstable and increase the normal curve to a hyperlordotic (overly curved) position. This is not a common problem in adults and more routinely is seen occurring in children with spinal cord tumors following surgery to remove the tumor.
4. Neuromuscular Lordosis
This group includes a large variety of conditions / disorders that can lead to many different types of spinal curvature problems. For each different disorder there are different treatment options.
5. Lordosis Secondary to Hip Flexion Contracture
This is a unique group of patients who develop a contracture of the hip joints causing the spine to be pulled out of alignment. This contracture can come from a variety of reasons including infection, injury, or muscle imbalance issues from a several different disorders.
Typically all that is needed to confirm and monitor a patient who may have an abnormal lordosis is an x-ray of the spine and clinical exam. Depending on the causes of the abnormal curve, a different course for treatment and follow up will be needed.
Most patients with any sort of lordosis will not require surgery or treatment except in the most extreme cases. Often, patients are manage with medications such as acetaminophen (Tylenol™), ibuprofen (Advil™), or Naprosyn (Aleve™) taken as needed for occasional back discomforts. Exercises taught by physical therapy are often very helpful for good back health and flexibility. These exercises should be use daily and can often replace the need for medications.
In the most severe patients with nerve problems, surgery is often necessary. It will stabilize the back bones and can correct some or all of the nerve problems with time and the right therapy following surgery.
When to be Concerned
If the curve of the spine has become so severe that the pain keeps someone, especially children from participating in activities they enjoy, a spine specialist should be seen to evaluate the problem. If at any point before, during, or after treatment for the back the child should have issues with the ability to walk, stand, or control bladder and bowel movements, this becomes an emergency situation and the child should be seen in the emergency department immediately.
When a child has vague back pain for two (2) weeks or more and has failed to improve their symptoms with rest, over the counter medications, ice and / or heat, and decreased activities, an evaluation by the child’s primary doctor (pediatrician) or spine specialist should be arranged at the earliest convenience.