The association of spinal osteoarthritis with lumbar lordosis

Abstract

Background: Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis.

Methods: 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1 was also measured.

Results and discussion: 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups

Conclusions: There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.

Figure 1

The load distribution on the intervertebral disk and apophyseal joints is altered when the transmission of weight changes.

Figure 2

Graph of the distribution of lordotic angles of the two groups.

Figure 3

Left: OA patient with minimal lordosis; L₁ - L₅ 6⁰, L₁ - S₁ 28⁰, L₅ - S₁ 21⁰. Right: OA patient with exaggerated lordosis; L ₁- L₅51⁰L₁- S₁70⁰L₅- S₁19⁰.