Changes in lumbar lordosis in young patients with low back pain during a 10-year period

Comparison of lumbar spinal angle between normal body mass index and overweight young adults

[Purpose] This study compared the upper and lower lumbar angles of normal body mass index and overweight young adults, and examined the relationships among body mass index, waist circumferences, and lumbar angles. [Subjects and Methods] Sixty participants aged 18–25 years were recruited and allocated to 2 groups (n=30 per group): normal body mass index (18.5–24.9 kg/m²) and overweight group (body mass index, ≥ 25.0 kg/m²). During lumbar angle measurement, the participants stood in a relaxed position with bare feet. The upper and lower lumbar angles of each participant were measured using a flexible ruler, and the angle calculated by the tangent method. The waist circumference was also measured. [Results] The mean lower lumbar angle in the overweight group was significantly greater than that of the normal body weight group. Moreover, only the lower lumbar angle was associated with a significant increase in the body mass index (r=0.28). Waist circumference showed no association with the lumbar angles. [Conclusion] This is the first study to suggest that increased body weight could cause lower lumbar angle deviation in young adults. Further studies should investigate individuals with symptomatic back pain or back dysfunction and the impact of body weight on lumbar spinal angles.

Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation

BACKGROUND CONTEXT

Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system.

PURPOSE

To report migration patterns of extruded lumbar disc fragments.

STUDY DESIGN

A review of magnetic resonance (MR) images.

PATIENT SAMPLE

A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation.

OUTCOME MEASURES

Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation.

METHODS

High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered "migrated." The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane.

RESULTS

In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (p<.001 for both). Radiculopathy was significantly more frequent in caudal migrations than in rostral migrations (78.9% vs. 65.1%, p<.001). There was no significant association between gender or BMI and migration patterns in the vertical plane. In the horizontal plane, central, paracentral, subarticular, foraminal, and extraforaminal migrations were reported in 17.3%, 74.2%, 4.3%, 2.5%, and 1.8% of the patients, respectively. The youngest (median age 39 years, interquartile range [IQR] 13 years) and the oldest (median age 55 years, IQR 15 years) groups of patients (p<.001) had the most formainal and extraforaminal migrations, respectively. Radiculopathy was present in 66.5%, 76.8%, 88.6%, 96%, and 27.8% of the patients with central, paracentral, subarticular, foraminal, and extraforaminal migrations, respectively (p<.001). No significant association was found between gender, BMI, or the level of herniation and migration pattern in the horizontal plane.

CONCLUSIONS

Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively. Age and the level of herniation may affect the migration patterns of herniated lumbar disc material.

[Lumbar hyperlordosis in children and adolescents at a privative school in southern Brazil: occurrence and associated factors]

Posture assessment during childhood and adolescence allows early detection of postural disorders and adoption of preventive measures. This study evaluated the occurrence of lumbar hyperlordosis and associated factors in 467 children and adolescents aged 10 to 16 years at a school in Porto Alegre, Rio Grande do Sul State, Brazil. Lumbar hyperlordosis was defined as increased lumbar curvature evaluated by photography. Prevalence of lumbar hyperlordosis was 78%. Factors positively associated with lumbar hyperlordosis were female gender (PR = 1.08; 95%CI: 1.03; 1.13), abdominal strength below the 20th percentile (PR = 1.10; 95%CI: 1.05; 1.15), and flexibility below the 20th percentile (PR = 1.07; 95%CI: 1.01; 1.12). Lumbar hyperlordois was negatively associated with lumbar mobility (PR = 0.90; 95%CI: 0.85; 0.96) and height (PR = 0.995; 95%CI: 0.99; 0.999). Effective strategies to improve physical fitness in schoolchildren are necessary, because low abdominal strength and low flexibility were associated with lumbar hyperlordosis.

Effect of age and lordotic angle on the level of lumbar disc herniation

It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA), as measured by Cobb's method. We followed retrospectively lumbosacral spine MRI's of 1419 patients with symptomatic disc herniation. Pearson's correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student's t-test was applied to assess gender differences. Young patients were found to have higher LLA (R = 0.44, P < 0.0001) and lower levels of disc herniation (R = 0.302, P < 0.0001), whereas older patients had higher level herniation in lower LLA group (mean LLA 28.6° and 25.4°) and lower level herniation in high LLA group (mean LLA 33.2°). We concluded that Lumbar lordotic Cobb's angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women (R = 0.341, P < 0.0001).