SIB#377- Formula for Ideal Lumbar Lordosis

The Study: Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population.

 The Facts: 

a. The study was done on asymptomatic subjects.  

b. The authors wished to find reference values for lumbar lordosis (LL) and to do the same for lower lumbar lordosis (LLL). 

c. They also wanted to see if there was a relationship between pelvic incidence (PI) and lumbar lordosis. 

d. The subjects were older Koreans with an average age of 64.1. 

e. They used standing x-rays of the whole spine, including the pelvis. 

f. They had 183 subjects but 33 were excluded because they exhibited certain spinal problems such as scoliosis, spondylolisthesis, compression fractures, etc. 

g. Total lumbar lordosis was found to be 57.5 plus or minus 9.0 degrees. 

h. Upper lumbar lordosis was 1.9 plus or minus 6.1 degrees. 

i. Middle lumbar lordosis was 16.1 plus or minus 5.2 degrees. 

j. Lower lumbar lordosis was 39.7 plus or minus 6.8 degrees.  

(Editor’s Note: This value is only 0.75 degrees less than the value most of us are familiar with, namely that the lower lumbar lordosis  normally comprises about 2/3 of the total lumbar lordosis. )

 k. Pelvic incidence 48.6 plus or minus 8.6 degrees. 

l. They concluded that: “The ideal values of PI–LL and PI–LLL were inconsistent,

and they have a positive correlation with PI in asymptomatic elderly population.”

Take Home:

The authors were not able to establish the ideal values of pelvic incidence to either total lumbar lordosis or lower lumbar lordosis although there was a correlation of pelvic incidence to both of those lordosis findings. They also broke the lumbar lordosis into parts instead of taking it as a whole and showed that the lower lumbar lordosis was where most of the lordosis took place.

 Reviewer's Comments:

This is another article that Dr. Keith Rau told me about. I like the way that they looked at the parts that make up total lordosis. We should recognize that we can have a total lordosis that is reasonable but have a part of that lordosis that is problematic. This is the same as in the rest of the spine where we can have a reasonably normal global posture but still have either regional or intersegmental problems. Once again this points out that we need to look at the whole picture.

 Reviewer:  Roger Coleman DC

 Editor’s Comments: Readers may have noticed the rather large value of 57.5 degrees obtained for the total lumbar lordosis.  This is because the authors chose to measure the total lumbar lordosis from the inferior endplate of T-12 down to the superior surface of S1 whereas most chiropractors are probably used to measuring the lumbar lordosis from L1-L5..

 Editor: Mark R. Payne DC

 Reference: Hyun SJ, Han S, Kim YB, Kim YJ, Kang GB, Cheong JY. Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population. Eur Spine J. 2019 Sep;28(9):1906-1913. doi: 10.1007/s00586-019-05955-w. Epub 2019 Mar 22.

 Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/30903294