Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers

Dreischarf, Marcel; Albiol, Laia; Rohlmann, A.; Pries, Esther; Bashkuev, Maxim; Zander, Thomas; Duda, Georg N.; Druschel, Claudia; Strube, Patrick; Putzier, Michael; Schmidt, Hendrik

doi:10.1371/journal.pone.0116186

Cited by 65 publications

(32 citation statements)

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“…; Dreischarf et al. ), but determining how sex affects flexion and extension separately at the intervertebral level may provide insight into how vertebral wedging impacts intervertebral motion and whether females have a greater range of lumbar spine extension.…”

Section: Discussionmentioning

confidence: 99%

“…Future studies will be directed to understanding sex-differences in the sagittal range of motion of the lumbar spine. Prior work has shown that there are sex-differences in sagittal range of motion of the lumbar spine (Burton & Tillotson, 1988;Sullivan et al 1994;Dreischarf et al 2014), but determining how sex affects flexion and extension separately at the intervertebral level may provide insight into how vertebral wedging impacts intervertebral motion and whether females have a greater range of lumbar spine extension.…”

Section: Discussionmentioning

confidence: 99%

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Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

et al. 2016

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Previous work suggests females are evolutionarily adapted to have greater lumbar lordosis than males to aid in pregnancy load-bearing, but no consensus exists. To explore further sex-differences in the lumbar spine, and to understand contradictions in the literature, we conducted a cross-sectional retrospective study of sex-differences in lumbar spine morphology and sacral orientation. In addition, our sample includes data for separate standing and supine samples of males and females to examine potential sex-differences in postural loading on lumbosacral morphology. We measured sagittal lumbosacral morphology on 200 radiographs. Measurements include: lumbar angle (L1-S1), lumbar vertebral body and disc wedging angles, sacral slope and pelvic incidence. Lumbar angle, representative of lordotic curvature between L1 and S1, was 7.3° greater in females than males, when standing. There were no significant sex-differences in lumbar angle when supine. This difference in standing lumbar angle can be explained by greater lordotic wedging of the lumbar vertebrae (L1-L5) in females. Additionally, sacral slope was greater in females than males, when standing. There were no significant sex-differences in pelvic incidence. Our results support that females have greater lumbar lordosis than males when standing, but not when supine - suggesting a potentially greater range of motion in the female spine. Furthermore, sex-differences in the lumbar spine appear to be supported by postural differences in sacral-orientation and morphological differences in the vertebral body wedging. A better understanding of sex-differences in lumbosacral morphology may explain sex-differences in spinal conditions, as well as promote necessary sex-specific treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

et al. 2016

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“…There are some reports regarding the decrease in LL in elderly populations. One paper mentioned that LL tended to decrease after 60 years of age 22 , and another paper stated that LL decreased after forty to fifty years of age 23 .…”

Section: Discussionmentioning

confidence: 99%

Relationship between lumbar lordosis and the ratio of the spinous process height to the anterior spinal column height

Inanami¹,

Iwai²,

Kaneko³

et al. 2020

Sci Rep

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purpose Global sagittal imbalance with lumbar hypo-lordosis leads to various problems in elderly populations and is often treated with long-segment fusion and osteotomy. these highly invasive procedures result in a wide range of rigid spines with a high rate of complications. Although some reports have mentioned the primary aetiology of hypo-lordosis, there is limited evidence. thus, understanding the exact underlying mechanism is required for developing minimally invasive procedures. this study aimed to investigate the factors related to lumbar lordosis (LL) in elderly people. Methods A total of ninety consecutive patients aged ≥ sixty years at a single spine centre were included. We measured LL, the anterior spinal column height consisting of vertebral bodies and intervertebral discs from L1 to L5 (ASC-5) and the sum of the spinous process heights from L1 to L5 (SP-5) with computed tomography in a supine position. The relationship between LL and the SP-5/ASC-5 ratio, SP-5, and ASC-5 was analysed. Results The Pearson correlation coefficients between LL and the SP-5/ASC-5 ratio, SP-5, and ASC-5 were −0.80 (p < 0.001), −0.43 (p < 0.001) and 0.36 (p < 0.001), respectively. Conclusion LL was significantly related to the SP-5/ASC-5 ratio of the lumbar spine in elderly people. In addition to shortening of the ASC, elongation of the SP-5 also contributed to a loss of LL. Global sagittal spine imbalance with lumbar hypo-lordosis has recently become well known as one of the major causes of reduced health-related quality of life in elderly populations 1,2. This degenerative condition can lead to various problems including low back pain during standing and walking 2,3. This outcome is mainly because the back muscles become exhausted to maintain an erect posture while the upper body spontaneously falls forward 2-4. Many patients have undergone long-segment spinal fusion surgeries with osteotomy for the correction of sagittal imbalance 5. These highly invasive operations may cause various perioperative and late complications. Perioperative complications include neurological dysfunction, excessive blood loss, delirium, and infection. Late complications include pseudo-arthrosis, instrumentation and/or graft failure as well as proximal junctional kyphosis 6-8. Hence, minimally invasive surgical methods are expected to be developed. To develop such treatments, it is necessary to better understand the aetiology of hypo-lordotic tendencies in the degenerative process. A few reports have stated that weakness and adipose degeneration of the back muscles can be the primary causes 9,10. Another report mentioned that an increase in spinous process (SP) height may cause hypo-lordosis 11. Because these studies have demonstrated limited evidence, further investigations are needed to elucidate the underlying mechanism of hypo-lordosis.

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“…Beside these factors, and others related to the variability of the lumbar spine as subject of study—number of vertebrae used, pathological or nonpathological spines, presence or absence of lumbosacral transitional vertebrae, presence or absence of scoliosis, and so forth, discrepancies found among studies of sexual dimorphism and population variation could also stem from differences in the inclusion/exclusion criteria used by each author, which are often based on the sample's age range. Some consider age‐related degeneration to have an influence on the lumbar curvature—either increasing it (Jentzsch et al, ) or decreasing it (Dreischarf et al, ; Gelb, Lenke, Bridwell, Blanke, & McEnery, ; Korovessis et al, ; Merrill et al, ; Pries et al, )—and prefer to choose a younger‐aged sample in order to eliminate its effect in studies where age variation is not the main subject of study (Bailey et al, ). On the contrary, other authors do not find any relation between lordosis and age (Kalichman et al, ), and thus do not make any exclusions regarding age.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the degree of lumbar lordosis varies greatly throughout an individual's life history—during postnatal ontogeny, the lumbar lordosis is established and reaches its initial adult configuration shortly after puberty (Reichmann & Lewin, ; Shefi et al, ). During adulthood, the lumbar lordosis can change further with the senescence process (Dreischarf et al, ; Jentzsch, Geiger, König, & Werner, ; Korovessis, Stamatakis, & Baikousis, ; Pries, Dreischarf, Bashkuev, Putzier, & Schmidt, ). These changes are closely related to factors such as bone and soft tissue degeneration (Bogduk, ), genetic make‐up variability in different populations (i.e., inter‐population variation) and sexual dimorphism.…”

Section: Introductionmentioning

confidence: 99%

3D geometric morphometric analysis of variation in the human lumbar spine

Zlolniski

Torres-Tamayo

García‐Martínez

et al. 2019

American J Phys Anthropol

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Objectives: The shape of the human lumbar spine is considered to be a consequence of erect posture. In addition, several other factors such as sexual dimorphism and variation in genetic backgrounds also influence lumbar vertebral morphology. Here we use 3D geometric morphometrics (GM) to analyze the 3D morphology of the lumbar spine in different human populations, exploring those potential causes of variation.Material and methods: We collected 390 (semi) landmarks from 3D models of the CT scans of lumbar spines of seven males and nine females from a Mediterranean population (Spain, Israel) and seven males and either females from a South African population for geometric morphometric (GM) analysis. We carried out Generalized Procrustes Analysis, Principal Components, and Regression analyses to evaluate shape variation; and complemented these analyses with the Cobb Method.Results: The Mediterranean sample was considerably more lordotic than the South African sample. In both populations, female lumbar spines showed proportionally narrower and more craniocaudally elongated lumbar segments than in males. In addition, the point of maximum curvature in females tended to be located more inferiorly than in males. Discussion:Our results show that sexual dimorphism is an important factor of lumbar spine variation that mainly affects features of lumbar spine robustness (height proportions) and the structure-but not the degree-of its curvature. Differences in lordosis, however, are clearer at the inter-population level. This reflects previous conflicting studies casting doubts on pregnancy as an adaptive factor influencing lordosis. Other factors, for example, shape of the individual lumbar vertebrae and intervertebral discs and their relative proportions within the lumbar spine should be considered when exploring variation in vertebral column morphology. K E Y W O R D Slordosis, Mediterranean Caucasian, population variation, sexual dimorphism, South African

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Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers

Cited by 65 publications

References 50 publications

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females

Relationship between lumbar lordosis and the ratio of the spinous process height to the anterior spinal column height

3D geometric morphometric analysis of variation in the human lumbar spine

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