Lumbo-Sacral Angle Evaluation Among Lebanese Population



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Submitted Nov 19, 2020
Published Jan 12, 2021
10.24018/clinicmed.2021.2.1.5

Abstract viewed = 309 times

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Background: Lumbar lordosis is an essential postural element that has gained the interest of both clinicians and researchers for several years. It is the inward curvature made by the wedging of the vertebrae of the lumbar spine. Since there is paucity of data on the lumbar lordosis in the Lebanese population, most of the data used in clinical practice to classify hypo- and hyper-lordosis are based on studies from other races.

Aim: To identify the normal LSA in a Lebanese population, then see if there is a difference between the races, and determine if this angle is affected by the gender or age.

Methods: A retrospective study established to measure lumbar lordosis using LSA technique. Lateral supine lumbosacral radiographs of 128 Lebanese subjects, aged between 19 and 84 years, were analyzed. Statistical analysis was done using SPSS version 20.0.

Results: The mean value (SD) of LSA was 38.980 ( + 9.90) with a min 15.70 and max 64.20. A significant difference was found between LSA and gender. However, there was no significant variation between this angle and age.

Conclusion: The mean value of this angle 38.980 ( + 9.90) may form a reference for the Lebanese population. The study demonstrated that lumbar lordosis is affected by race and gender, with females having a greater LSA than males. Whereas, the latter wasn’t affected by age.

Keywords: Lumbar lordosis, Lebanese population, lumbosacral angle, radiography.

References

  1. Been, E., & Kalichman, L. (2014). Lumbar lordosis. Spine J. doi:10.1016/j.spinee.2013.07.464.
     Google Scholar
  2. Onyemaechi, N. O. (2016). Evaluation of lumbar angles and their clinical correlates in a Nigerian population. International journal of research in medical sciences, 4. doi:http://dx.doi.org/10.18203/2320-6012.ijrms20161753.
     Google Scholar
  3. Truchon, M. (2001). Determinants of chronic disability related to low back pain: Towards an integrative biopsychosocial model. Disability and Rehabilitation, 23, 758-767. doi:10.1080/09638280110061744.
     Google Scholar
  4. Burton, A. K., Tillotson, K. M., & Main, C. J. (1995). Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine, 20, 722-728. doi: https://doi.org/10.1097/00007632-199503150-00014.
     Google Scholar
  5. Chun, S., Lim, C., Kim, K., Hwang, J., & Chung, S. (2017, August 17). The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal. doi: 10.1016/j.spinee.2017.04.034.
     Google Scholar
  6. Demir, M., Gümüsburun, E., Seringec, N., Cicek, M., Ertugrul, R., & Güneri, B. (2018). Radiographic analysis of the lumbar and sacral region angles in young Turkish adults. Journal of the Pakistan Medical Association, 1212-1216. Retrieved from https://www.researchgate.net/publication/326839656.
     Google Scholar
  7. Vrtovec, T., Pernusˇ, F., & Likar, B. (2009). A review of methods for quantitative evaluation. European Spine Journal, 18, 593-607. doi:10.1007/s00586-009-0913-0.
     Google Scholar
  8. Berglund, L., Aasa, B., Michaelson, P., & Aasa, U. (2017): Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises – a randomized controlled trial. The Spine Journal, 18(3), 399-406. doi:10.1016/j.spinee.2017.07.178.
     Google Scholar
  9. Dreischarf, M., Pries, E., Bashkuev, M., Putzier, M., Schmidt, H., 2016. Differences between clinical ‘‘snap-shot” and ‘‘real-life” assessments of lumbar spine alignment and motion – What is the ‘‘real” lumbar lordosis of a human being? J. Biomech. 49, 638–644. https://doi.org/10.1016/j.jbiomech.2016.01.032.
     Google Scholar
  10. Okpala F. (2014). Measurement of lumbosacral angle in normal radiographs: a retrospective study in southeast Nigeria. Annals of medical and health sciences research, 4(5), 757–762. https://doi.org/10.4103/2141-9248.141548.
     Google Scholar
  11. Wiltse, L. L., & Winter, R. B. (1983). Terminology and measurement of spondylolisthesis. The Journal of bone and joint surgery. American volume, 65(6), 768–772.
     Google Scholar
  12. Fernand, R., Fox, D.E., 1985. Evaluation of Lumbar Lordosis. Spine (Phila. Pa. 1976) 10, 799–803. https://doi.org/10.1097/00007632-198511000-00003.
     Google Scholar
  13. Oliver, J., & Middleditch, A. (1994). Functional anatomy of the spine. In Functional Anatomy of the Spine (pp. 328-328).
     Google Scholar
  14. Hwang, S. H., Park, S. W., & Kim, Y. H. (2009). Measurement Comparison about Lumbar Lordosis: Radiography and 3D Motion Capture. (O. Dössel, & W. C. Schlegel, Eds.) World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany. doi:10.1007/978-3-642-03882-2_442.
     Google Scholar
  15. Kim, H.-J., Chung, S., Kim, S., Shin, H., Lee, J., Kim, S., & Song, M.-Y. (2006). Influences of trunk muscles on lumbar lordosis and sacral angle. European Spine Journal. doi:10.1007/s00586-005-0976-5.
     Google Scholar
  16. Hay et al., 2015
     Google Scholar
  17. Youdas, J.W., Hollman, J.H., Krause, D.A., 2006. The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain. Physiother. Theory Pract. 22, 229–237. https://doi.org/10.1080/09593980600927864.
     Google Scholar
  18. Koumantakis et al., 2016
     Google Scholar
  19. Kalichman, L., Li, L., Hunter, D. J., & Been, E. (2011). Association between computed tomography-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position. The spine journal: official journal of the North American Spine Society, 11(4), 308–315. https://doi.org/10.1016/j.spinee.2011.02.010.
     Google Scholar
  20. Gelb, D.E., Lenke, L.G., Bridwell, K.H., Blanke, K., McEnery, K.W., 1995. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila. Pa. 1976) 20, 1351–1358.
     Google Scholar
  21. Murrie, V. L., Dixon, A. K., Hollingworth, W., Wilson, H., & Doyle, T. A. (2003). Lumbar lordosis: study of patients with and without low back pain. Clinical anatomy (New York, N.Y.), 16(2), 144–147. https://doi.org/10.1002/ca.10114.
     Google Scholar
  22. Vialle, R., Levassor, N., Rillardon, L., Templier, A., Skalli, W., Guigui, P., 2005. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J. Bone Jt. Surg. - Ser. A 87, 260–267. https://doi.org/10.2106/JBJS.D.02043.
     Google Scholar
  23. Youdas, J. W., Garrett, T. R., Egan, K. S., & Therneau, T. M. (2000). Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Physical therapy, 80(3), 261–275.
     Google Scholar
  24. Youdas, J.W., Garrett, T.R., Harmsen, S., Suman, V.J., Carey, J.R., 1996. Lumbar lordosis and pelvic inclination of asymptomatic adults. Phys. Ther. 76, 1066–1081. https://doi.org/10.1093/ptj/77.4.439.
     Google Scholar
  25. Naido M., 2008. The evaluation of radiographic measurements of the lumbar spine in young to middle aged Indian females in Durban. Durban, South Africa: Durban University of Technology, 111.
     Google Scholar
  26. Tüzün, C., Yorulmaz, I., Cindas, A., Vatan, S., 1999. Low back pain and posture. Clin. Rheumatol. 18, 308–312. https://doi.org/10.3760/cma.j.issn.0366-6999.2010.07.014.
     Google Scholar
  27. Amonoo-Kuofi, H.S., 1992. Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging. Acta Anat. (Basel) 145, 373–377.
     Google Scholar
  28. Chernukha, K. V., Daffner, R. H., & Reigel, D. H. (1998). Lumbar lordosis measurement: a new method versus Cobb technique. Spine, 23(1), 74-79.
     Google Scholar
  29. Alexander, C. E., & Dulebohn., S. C. (2017). StatPearls: Lumbosacral Radiculopathy. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430837/.
     Google Scholar
  30. Ayad, C. E., Wahby, D. M.-A., Abdalla, E. A., & Kajoak, S. A. (2013). Evaluation of Lumber Lordotic Angle in Patients with Intervertebral Disc Prolapse using Cobb's Method. Global Journal of Medical Research Interdisciplinary, 13(7).
     Google Scholar
  31. Bogduk, N. (1991). The lumbar disc and low back pain. Neurosurgery Clinics of North America, 2(4), 791-806.
     Google Scholar
  32. Bogduk, N. (2005). Clinical anatomy of the lumbar spine and sacrum. Elsevier Health Sciences.
     Google Scholar
  33. Burdett, R. G., Brown, K. E., & Fall, M. P. (1986). Reliability and validity of four instruments for measuring lumbar spine and pelvic positions. Physical therapy, 66(5), 677-684.
     Google Scholar
  34. Dehghan, F., Haerian, B.S., Muniandy, S., Yusof, A., Dragoo, J.L., Salleh, N., 2014. The effect of relaxin on the musculoskeletal system. Scand. J. Med. Sci. Sport. 24, 220–229. https://doi.org/10.1111/sms.12149.
     Google Scholar
  35. Dreischarf, M., Albiol, L., Rohlmann, A., Pries, E., Bashkuev, M., Zander, T., Schmidt, H. (2014). Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers. PLOS ONE, 9(12). doi:10.1371/journal.pone.0116186.
     Google Scholar
  36. Evcik, D., & Yücel, A. (2003). Lumbar lordosis in acute and chronic low back pain patients. Rheumatology International, 23(4), 163-165.
     Google Scholar
  37. Gierthmühlen, J., Greinacher, J., Höper, J., Oberlojer, V., Lankes, M., Traulsen, F., Baron, R. (2017). Sensory symptoms in low back pain-how do they matter? Current Medical Research and Opinion.
     Google Scholar
  38. Gilbert, J. W., Wheeler, G. R., Storey, B. B., Mick, G. E., Herder, S. L., Richardson, G., Martinb, J. C. (2009). Lumbar magnetic resonance imaging hypolordosis in symptomatic patients: association with paraspinal muscle spasms. Journal of Chiropractic Medicine. doi: 10.1016/j.jcm.2009.05.001.
     Google Scholar
  39. Gilleard, Wendy, L., Brown, 1996. Structure and function of the abdominal muscles in primigravid. J Mark MPhys. Ther. Nurs. Allied Heal. Database pg 76, 750–762.
     Google Scholar
  40. Ginanneschi, F., Mondelli, M., Piu, P., & Rossi, A. (2015). Pathophysiology of knee jerk reflex abnormalities in L5 root injury. Functional Neurology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610754/.
     Google Scholar
  41. Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare. doi:10.3390/healthcare4020022.
     Google Scholar
  42. Hacking, C., & al., A. T. (2013). Cobb angle. Radiopaedia. Retrieved from https://radiopaedia.org/articles/cobb-angle.
     Google Scholar
  43. Hegmann, K. T. (2016). Low Back Disorders. American College of Occupational and Environmental Medicine.
     Google Scholar
  44. Hong, J. Y., Suh, S. W., Modi, H. N., Hur, C. Y., Song, H. R., & Park, J. H. (2010). Reliability analysis for radiographic measures of lumbar lordosis in adult scoliosis: a case–control study comparing 6 methods. European Spine Journal. doi:10.1007/s00586-010-1422-x.
     Google Scholar
  45. Huang, Y. P., Bruijn, S. M., Lin, J. H., Meijer, O. G., Wu, W. H., Abbasi-Bafghi, H., Dieën, J. H. (2011). Gait adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing. European Spine Journal. doi: 10.1007/s00586-010-1639-8.
     Google Scholar
  46. Lee, J. H., & Lee, S.-H. (2017). Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black? Indian Journal of Orthopaedics. doi:10.4103/0019-5413.201713.
     Google Scholar
  47. Levine, D. B. (2010). The Hospital for Special Surgery 1955 to 1972: T. Campbell Thompson Serves as Sixth Surgeon-in-Chief 1955–1963 Followed by Robert Lee Patterson, Jr. the Seventh Surgeon-in-Chief 1963–1972. HSS Journal. doi:10.1007/s11420-009-9136-5.
     Google Scholar
  48. Marnach, M.L., Ramin, K.D., Ramsey, P.S., Song, S.W., Stensland, J.J., An, K.N., 2003. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet. Gynecol. 101, 331–335. https://doi.org/10.1016/S0029-7844(02)02447-X.
     Google Scholar
  49. McCarthy, J. J., & Betz, R. R. (2000). The relationship between tight hamstrings and lumbar hypolordosis in children with cerebral palsy. Spine, 25(2), 211–213. https://doi.org/10.1097/00007632-200001150-00011.
     Google Scholar
  50. Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., ... & Wenger, N. K. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation, CIR-0000000000000351.
     Google Scholar
  51. Mehta, R. S., Nagrale, S., Dabadghav, R., Rairikar, S., Shayam, A., & Sancheti, P. (2016). Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals. Asian Spine Journal. doi: 10.4184/asj.2016.10.3.495.
     Google Scholar
  52. Mirbagheri, S. S., Rahmani-Rasa, A., Farmani, F., Amini, P., & Nikoo, M. R. (2015). Evaluating kyphosis and lordosis in students by using a flexible ruler and their relationship with severity and frequency of thoracic and lumbar pain. Asian spine journal, 9(3), 416-422. doi: 10.4184/asj.2015.9.3.416.
     Google Scholar
  53. Mosner, E. A., Bryan, J. M., Stull, M. A., & Shippee, R. (1989). A comparison of actual and apparent lumbar lordosis in black and white adult females. Spine, 14(3), 310–314. https://doi.org/10.1097/00007632-198903000-00011.
     Google Scholar
  54. O’Rahilly, R., Müller, F., Carpenter, S., & Swenson, R. (2004). Basic human anatomy: a regional study of human structure.
     Google Scholar
  55. Okpala, F. O. (2016). Normal pediatric lumbar lordosis: Measurement of magnitude and age of maximum development using three radiographic techniques. West African Journal of Radiology, 23(2), 82-88. doi:10.4103/1115-3474.172093.
     Google Scholar
  56. Purves (2004). Neuroscience: Third Edition. Massachusetts, Sinauer Associates, Inc.
     Google Scholar
  57. Saladin, K. S. (2007). Human Anatomy. Springer.
     Google Scholar
  58. Sam, E. M. (2011). Problem Based Neurosurgery. World Scientific.
     Google Scholar
  59. Shier, D., Butler, J., & Lewis, R. (2001). Human anatomy and physiology. Boston, MA, USA: McGraw-Hill.
     Google Scholar
  60. Stagnara, P., De Mauroy, J.C., Dran, G., Gonon, G.P., Costanzo, G., Dimnet, J., Pasquet, A., 1982. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila. Pa. 1976) 7, 335–342.
     Google Scholar
  61. Stone, J., & Vermeulen, M. (2016). Functional sensory symptoms. Handbook of Clinical Neurology. doi:10.1016/B978-0-12-801772-2.00024-2.
     Google Scholar
  62. Takao S, Sakai T, Sairyo K, et al. (2010) Radiographic comparison between male and female patients with lumbar spondylolysis. J Med Invest 57:133–7.
     Google Scholar
  63. Tortora, G. J., & Derrickson, B. (2013). Essentials of anatomy and physiology. Wiley.
     Google Scholar
  64. Walker, H. K. (1990). Clinical Methods: The History, Physical, and Laboratory Examinations. (3rd ed.).
     Google Scholar

  65.  Google Scholar
  66. Yousef, A.M., Hanfy, H.M., Elshamy, F.F., Awad, M.A., Kandil, I.M., 2011. Postural changes during normal pregnancy. J. Am. Sci. 7, 1013–1018. https://doi.org/10.1017/CBO9781107415324.004.
     Google Scholar
  67. Zaproudina, N., Ming, Z., & Närhi, M. (2015). Sensory and sympathetic disorders in chronic non-specific neck pain. Functional Neurology. doi: 10.11138/FNeur/2015.30.3.165.
     Google Scholar