Lordosis

lordosis
Fig. 1. Pathological lordosis when flexion contracture of the thigh.
Fig. 2. Hiperlans in rickets

Lordosis is a curvature of the spine, the bulge facing the front. Pronouncedly lordosis of the cervical and lumbar spine is a physiological; occurs in the first year of life, when you change the statics of the child. In norm the top of cervical lordosis is located at the level of V - VI cervical spine, lumbar - level III - VI of the lumbar vertebrae. Pathological lordosis may be congenital or acquired, often in combination with other distortions. Hiperlans - pathological deepening of lordosis - occurs when spondylolisthesis (offset vertebra to the front - most V lumbar), bilateral hip dislocation, various contractures (Fig. 1), Kashin - Beck disease (see), ankylosis (see), the weakening of the abdominal muscles, the result of rickets (Fig. 2), during pregnancy; cervical hiperlans may be caused by scarring after burns. Hyperlens is non-fixed, partially or completely fixed. When hyperlordosis body vertebrae move forward, spreading fan-shaped, and spinous processes converge, compressed; intervertebral disks obezobrazit. Clinic: strain, poor posture, pain due to compression of the roots of the nerves, restriction of movement.
Treatment: removal of the main disease, exercise therapy, massage, thermal procedures; unloading of a spine, rational patient positioning on the back, on the side with bent legs, prosthetics corset.

Lordosis (gr. lordosis) - curvature of the spine, the bulge facing the front. Lordosis of the cervical and lumbar spine (moderate) is a physiological (Fig. 1); it occurs in the post-embryonic human life in connection with the new static conditions, when the child begins to sit, and then to walk. Cervical physiological lordosis captures all cervical and two upper thoracic vertebra; the top of curvature is CV-VI. Lumbar lordosis form DXI-XII and all lumbar vertebrae; the top of his projected between LIII-IV.
Pathological lordosis may be congenital and much less frequently purchased. The latter occurs mainly in combination with other spinal deformities. The most common excessive lordosis (hyperlordosis) the lumbar-sacral spine, compensating kyphotic curvature higher - and lower divisions (Fig. 5-8).

Fig. 1. The development of physiological spinal curvature in humans: 1 - General kyphosis of the spinal column in the newborn; 2 - the development of cervical lordosis; 3 - the development of lumbar lordosis.

compensatory reinforced lumbar lordosis
Fig. 2-8. Compensatory reinforced lumbar lordosis: Fig. 2 - when the rear hip dislocation; Fig. 3 - with tubercular contracture of the hip joint; Fig. 4 - in infectious ankylosis of hip joints in position hip flexion; Fig. 5 - in rickety child; Fig. 6 - dramatically expressed rachitic thoracic kyphosis; Fig. 7 - by osteochondropathy spine disease Leiermann); Fig. 8 - when illness Kashin - Beck ("family" deformation).

Lumbar hiperlans (Fig. 2-4) static origin usually formed in spondylolisthesis, with bilateral hip dislocation, contracture or ankylosis his due dysplasia, consumptive or non-specific caxita. The mechanism of formation of hyperlordosis is determined by shifting the centre of gravity of the body backwards; the higher the deviation of the center of gravity, the more deepens and lordosis.
In the cervical spine pathological lordosis may occur due to Scar concretions (for example, after burn back, nuchal, the neck).
Morphological changes in pathological lordosis usually are offset in front and fan-shaped divergence of the vertebral bodies, wedge-shaped expansion of the intervertebral discs in the front section and the rarefaction of bone structure. Spinous processes of the vertebrae in departments related with deformed, on the contrary, are sealed and converging. Quite frequent type of osteoarthritis of the intervertebral joints; lordosis in the prone position, smoothed, but it may become fixed.
The clinical picture in pathological lordosis consists of strain, pain and movement restrictions (only active when compensatory flow forms and active and passive - fixed hyperlordosis). The presence of L. cause other deformations of the body; so, the younger the patient, the more you are exposed to secondary deformation of the rib cage and chest cavity, the function of which is very disturbed; may arise static deformation and other parts of the body.
Treatment of hyperlordosis should consist primarily in radical elimination of the underlying disease, after L. completely or almost completely normal. When pain showed the analgesic media, various heat treatments, therapeutic exercises, unloading and balneotherapy, sometimes wearing corsets, bandages.
X-ray diagnostics. A correct understanding of degrees abnormal curvature of the spine in the cervical and lumbar it departments can be obtained in the study of lateral spine radiographs with maximum flexion and extension. This is determined by the mobility of the spine in the sagittal plane (normal, enhanced and reduced). A precise definition of the degree of mobility does not exist, however, to establish the differences in its extreme and intermediate levels by measuring the x-ray lateral projection is possible.
Accurate measurement may be needed only for some special purposes. In practical x-rays is important to use data from a regular x-rays of the spine straight and lateral projections. With increased lordosis of the lumbar spine in the result of years of contiguous provisions of the spinous processes (under the influence of different conditions - congenital dislocation, spondylolisthesis, obesity and so on) are formed between them anomalous coupling (neurotron), which can develop phenomenon and deforming osteoarthrosis (Fig. 9 and 10).

Fig. 9. Newartriot between the spinous processes of the fourth and fifth lumbar vertebrae (arrow): 1 - lateral projection; 2 - in direct projection.
Fig. 10. Deforming osteoarthritis in the newly formed joint between the spinous processes of III and IV of the lumbar vertebrae (arrow).

On the other hand, the sharp decline in the natural lordosis or even its total absence of an objective symptom of intensive reduction of muscles due to pain with a completely unmodified state of the bone apparatus spine.
It is necessary to note the presence of a strongly pronounced lordosis in some people, which is important when performing the x-ray in direct projection. For the best in such cases, the image of the lower cervical and fifth lumbar vertebrae and intervertebral spaces in direct projection is necessary to give the direction of the Central beam from the feet to the head (cauda-cranial direction) with deviation from the perpendicular within 10-20 degrees. For the upper lumbar vertebrae by amplifying L. should be sent to the Central ray in the opposite direction (cranio-caudal), i.e., from head to foot.