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Erschienen in: European Spine Journal 12/2023

01.09.2023 | Original Article

Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study

verfasst von: Mustafa Tekeli, Huseyin Erdem, Nazire Kilic, Neslihan Boyan, Ozkan Oguz, Roger W. Soames

Erschienen in: European Spine Journal | Ausgabe 12/2023

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Abstract

Purpose

The aim of this study; evaluate lumbar lordosis (LL) in symptomatic individuals with six different techniques and to examine the techniques comparatively. Thus, to provide an overview of lumbal lordosis and techniques.

Methods

Cobb L1-L5, Cobb L1-S1, Posterior Tangent, tangential radiologic assessment of lumbar lordosis (TRALL), vertebral centroid measurement of lumbar lordosis (CLL) and Risser Ferguson measurement techniques were used to assess LL from radiographs of 175 symptomatic adults. Correlations between techniques and relationship between the measurements obtained, gender and age were analyzed. Also ınterclass correlation (ICC) analyzed. Bland–Altman plots were performed to compare the techniques with Cobb.

Results

ICC for all methods were greater than 0.96. For each method, no difference in LL was observed with respect to gender or age (p > 0.05). High positive correlation was observed between the Risser Ferguson, Posterior Tangent, Cobb L1-L5, Cobb L1-S1 and CLL techniques (p < 0.001), and moderate positive correlation between TRALL and all other techniques (p < 0.001).

Conclusion

In this study, it was found that the mean lumbar lordosis values of symptomatic participants were lower than most of the other asymptomatic studies in the literature and there was no significant difference in lumbar lordosis values in terms of gender and age in symptomatic individuals. Based on statistical findings, Risser Ferguson can be used to assess LL. These results and the data obtained as a result of the comparative examination of techniques according to age groups and gender will benefit clinicians and those working in the field by providing a better understanding LL.
Literatur
1.
Zurück zum Zitat Önen MR, Naderi S (2013) Spinal deformitelere genel Yaklaşım. Türk Nöroşirürji Dergisi 23(2):1–12 Önen MR, Naderi S (2013) Spinal deformitelere genel Yaklaşım. Türk Nöroşirürji Dergisi 23(2):1–12
2.
Zurück zum Zitat Üzümcügil O, Benli İT, Ofluoğlu E (eds) (2016) Omurganın sagital plan deformiteleri. Türk Omurga Derneği Yayınları, Fatih Üzümcügil O, Benli İT, Ofluoğlu E (eds) (2016) Omurganın sagital plan deformiteleri. Türk Omurga Derneği Yayınları, Fatih
3.
Zurück zum Zitat Arıncı K, Anatomi EA, Kitapevi G (2006) 1. cilt. 4. baskı Arıncı K, Anatomi EA, Kitapevi G (2006) 1. cilt. 4. baskı
4.
Zurück zum Zitat Battié MC, Videman T, Kaprio J et al (2009) The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J 9:47–59PubMed Battié MC, Videman T, Kaprio J et al (2009) The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J 9:47–59PubMed
5.
Zurück zum Zitat Cote P, Cassidy JD, Yong-Hing K et al (1997) Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured relaibly on radiographs? Spine 22:859–864PubMed Cote P, Cassidy JD, Yong-Hing K et al (1997) Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured relaibly on radiographs? Spine 22:859–864PubMed
6.
Zurück zum Zitat Adams MA, Hutton WC (1985) The effect of posture on the lumbar spine. J Bone Joint Surg [Br] 67:625–629 Adams MA, Hutton WC (1985) The effect of posture on the lumbar spine. J Bone Joint Surg [Br] 67:625–629
7.
Zurück zum Zitat Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721PubMed Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721PubMed
8.
Zurück zum Zitat Chokshi FH, Kadom N, Dwivedi N et al (2019) Radiographic Cobb angle: a feature of congenital lumbar spine stenosis. Curr Probl Diagn Radiol 48(1):45–49PubMed Chokshi FH, Kadom N, Dwivedi N et al (2019) Radiographic Cobb angle: a feature of congenital lumbar spine stenosis. Curr Probl Diagn Radiol 48(1):45–49PubMed
9.
Zurück zum Zitat Sunami T, Kotani T, Aoki Y et al (2022) Large lumbar lordosis is a risk factor for lumbar spondylolysis in patients with adolescent idiopathic scoliosis. Spine 47(1):76–81PubMed Sunami T, Kotani T, Aoki Y et al (2022) Large lumbar lordosis is a risk factor for lumbar spondylolysis in patients with adolescent idiopathic scoliosis. Spine 47(1):76–81PubMed
10.
Zurück zum Zitat Kawkabani G, Saliby RM, Mekhael M et al (2021) Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture 88:203–209PubMed Kawkabani G, Saliby RM, Mekhael M et al (2021) Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture 88:203–209PubMed
11.
Zurück zum Zitat Karademìr M, Karavelioğlu E, Boyaci MG et al (2014) Omurgada sagittal dengenin önemi ve spinopelvik parametreler. J Turkish Spinal Surg 25(2):139–148 Karademìr M, Karavelioğlu E, Boyaci MG et al (2014) Omurgada sagittal dengenin önemi ve spinopelvik parametreler. J Turkish Spinal Surg 25(2):139–148
12.
Zurück zum Zitat Berlemann U et al (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. Clin Spine Surg 12(1):68–73 Berlemann U et al (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. Clin Spine Surg 12(1):68–73
13.
Zurück zum Zitat Adams MA, Mannion AF, Dolan P (1999) Personal risk factors for first-time low back pain. Spine 24(23):2497PubMed Adams MA, Mannion AF, Dolan P (1999) Personal risk factors for first-time low back pain. Spine 24(23):2497PubMed
14.
Zurück zum Zitat Booth KC et al (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24(16):1712PubMed Booth KC et al (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24(16):1712PubMed
15.
Zurück zum Zitat Been E, Kalichman L (2014) Lumbar lordosis. Spine J 14(1):87–97PubMed Been E, Kalichman L (2014) Lumbar lordosis. Spine J 14(1):87–97PubMed
16.
Zurück zum Zitat Schwab F et al (2009) P26 Pre-operative pelvic parameters must be considered to achieve adequate sagittal balance after lumbar osteotomy. Spine J 9(10):129S Schwab F et al (2009) P26 Pre-operative pelvic parameters must be considered to achieve adequate sagittal balance after lumbar osteotomy. Spine J 9(10):129S
17.
Zurück zum Zitat Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT (2020) Measurement of lumbar Lordosis: a comparison of 2 alternatives to the cobb angle. J Manipulative Physiol Ther 43(8):760–767PubMed Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT (2020) Measurement of lumbar Lordosis: a comparison of 2 alternatives to the cobb angle. J Manipulative Physiol Ther 43(8):760–767PubMed
18.
Zurück zum Zitat Hong JY et al (2010) Reliability analysis for radiographic measures of lumbar lordosis in adult scoliosis: a case–control study comparing 6 methods. Eur Spine J 19:1551–1557PubMedPubMedCentral Hong JY et al (2010) Reliability analysis for radiographic measures of lumbar lordosis in adult scoliosis: a case–control study comparing 6 methods. Eur Spine J 19:1551–1557PubMedPubMedCentral
19.
Zurück zum Zitat Lee JS et al (2013) Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis. Eur Spine J 22:813–818PubMed Lee JS et al (2013) Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis. Eur Spine J 22:813–818PubMed
20.
Zurück zum Zitat Berlemann U et al (1998) Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism. Eur Spine J 7:376–380PubMedPubMedCentral Berlemann U et al (1998) Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism. Eur Spine J 7:376–380PubMedPubMedCentral
21.
Zurück zum Zitat Vrtovec T, Pernuš F, Likar B (2009) A review of methods for quantitative evaluation of spinal curvature. Eur Spine J 18:593–607PubMed Vrtovec T, Pernuš F, Likar B (2009) A review of methods for quantitative evaluation of spinal curvature. Eur Spine J 18:593–607PubMed
22.
Zurück zum Zitat Celestre PC, Dimar JR, Glassman SD (2018) Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: what does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am 29(3):323–329PubMed Celestre PC, Dimar JR, Glassman SD (2018) Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope: what does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am 29(3):323–329PubMed
23.
Zurück zum Zitat Anderson ROBERT (1999) Human evolution, low back pain. Evolut Med 17:333 Anderson ROBERT (1999) Human evolution, low back pain. Evolut Med 17:333
24.
Zurück zum Zitat Lang-Tapia M, España-Romero V, Anelo J et al (2011) Differences on spinal curvature in standing position by gender, age and weight status using a noninvasive method. J Appl Biomech 27:143–150PubMed Lang-Tapia M, España-Romero V, Anelo J et al (2011) Differences on spinal curvature in standing position by gender, age and weight status using a noninvasive method. J Appl Biomech 27:143–150PubMed
25.
Zurück zum Zitat Gelb DE et al (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20(12):1351–1358PubMed Gelb DE et al (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20(12):1351–1358PubMed
26.
Zurück zum Zitat Legaye J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedPubMedCentral Legaye J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103PubMedPubMedCentral
27.
Zurück zum Zitat Harrison DE, Harrison DD, Cailliet R et al (2001) Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine 26:E235-242PubMed Harrison DE, Harrison DD, Cailliet R et al (2001) Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine 26:E235-242PubMed
28.
Zurück zum Zitat Korovessis P, Stamatakis M, Baikousis A (1999) Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients. J Spinal Disord 12(2):131–137PubMed Korovessis P, Stamatakis M, Baikousis A (1999) Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients. J Spinal Disord 12(2):131–137PubMed
29.
Zurück zum Zitat Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine 23(6):700–704PubMed Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine 23(6):700–704PubMed
30.
Zurück zum Zitat Gülru ESEN et al (2020) Sağlıklı yetişkinlerde lumbal lordoz ve lumbosakral bölgenin fizyolojik sagital indeks değerleri. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi 6(3):343–356 Gülru ESEN et al (2020) Sağlıklı yetişkinlerde lumbal lordoz ve lumbosakral bölgenin fizyolojik sagital indeks değerleri. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi 6(3):343–356
31.
Zurück zum Zitat Vialle RAPHAËL et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. JBJS 87(2):260–267 Vialle RAPHAËL et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. JBJS 87(2):260–267
32.
Zurück zum Zitat Patrick N, Emanski E, Knaub MA (2014) Acute and chronic low back pain. Med Clin 98(4):777–789 Patrick N, Emanski E, Knaub MA (2014) Acute and chronic low back pain. Med Clin 98(4):777–789
33.
Zurück zum Zitat Chen YL (1999) Centroid measurement of lumbar lordosis compared with the Cobb technique. Spine 24:1786–1790PubMed Chen YL (1999) Centroid measurement of lumbar lordosis compared with the Cobb technique. Spine 24:1786–1790PubMed
34.
Zurück zum Zitat Okpala FO (2018) Comparison of four radiographic angular measures of lumbar lordosis. J Neurosci Rural Pract 09(03):298–304 Okpala FO (2018) Comparison of four radiographic angular measures of lumbar lordosis. J Neurosci Rural Pract 09(03):298–304
35.
Zurück zum Zitat Chernukha KV, Daffner RH, Reigel DH (1998) Lumbar lordosis measurement A new method versus Cobb technique. Spine 23:74–79PubMed Chernukha KV, Daffner RH, Reigel DH (1998) Lumbar lordosis measurement A new method versus Cobb technique. Spine 23:74–79PubMed
36.
Zurück zum Zitat OKCU G et al. (2000) Lomber Omurganın Sagittal planda radyolojik analizi OKCU G et al. (2000) Lomber Omurganın Sagittal planda radyolojik analizi
37.
Zurück zum Zitat Demir M et al (2018) Radiographic analysis of the lumbar and sacral region angles in young Turkish adults. J Pak Med Assoc 68(8):1212–1216PubMed Demir M et al (2018) Radiographic analysis of the lumbar and sacral region angles in young Turkish adults. J Pak Med Assoc 68(8):1212–1216PubMed
38.
Zurück zum Zitat Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19(14):1611–1618PubMed Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19(14):1611–1618PubMed
39.
Zurück zum Zitat Araújo F et al (2014) Individual and contextual characteristics as determinants of sagittal standing posture: a population-based study of adults. Spine J 14(10):2373–2383PubMed Araújo F et al (2014) Individual and contextual characteristics as determinants of sagittal standing posture: a population-based study of adults. Spine J 14(10):2373–2383PubMed
40.
Zurück zum Zitat Cobb JR (1948) Outline for the study of scoliosis. Instr Course Lect 5:261–275 Cobb JR (1948) Outline for the study of scoliosis. Instr Course Lect 5:261–275
41.
Zurück zum Zitat Janik TJ et al (1998) Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Res 16(6):766–770PubMed Janik TJ et al (1998) Can the sagittal lumbar curvature be closely approximated by an ellipse? J Orthop Res 16(6):766–770PubMed
42.
Zurück zum Zitat Chen Y, Chen W, Chiou W (2007) An alternative method for measuring scoliosis curvature. Orthopedics-New Jersey- 30(10):828 Chen Y, Chen W, Chiou W (2007) An alternative method for measuring scoliosis curvature. Orthopedics-New Jersey- 30(10):828
43.
Zurück zum Zitat Ferguson AB (1930) Study and treatment of scoliosis. South M J 23:116 Ferguson AB (1930) Study and treatment of scoliosis. South M J 23:116
Metadaten
Titel
Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study
verfasst von
Mustafa Tekeli
Huseyin Erdem
Nazire Kilic
Neslihan Boyan
Ozkan Oguz
Roger W. Soames
Publikationsdatum
01.09.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 12/2023
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-023-07886-z

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