Abstract
BackgroundDegenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Excessive loading of lumbar joints is a risk factor for DJD. Changes in lumbar lordosis significantly redistribute the forces of weight-bearing on the facet joints and the intervertebral discs. However, the relationship between lumbar lordosis and DJD has not been characterized in men and women.MethodsWe characterised the correlation between standing lumbar lordosis and DJD in standing radiographic images from 301 adult female and male chiropractic patients. DJD was rated using the Kellgren-Lawrence scale, and lordosis was measured using the Cobb angle. Linear and curvilinear correlations were investigated while controlling for age and sex.ResultsWe found a highly significant curvilinear correlation between lordosis and DJD of the lower lumbar spine in both sexes, but especially in women, irrespective of the effects of age. We found the effect size of lordosis on lower lumbar DJD to be between 17.4 and 18.1% in women and 12.9% in older men. In addition, lordosis of 65 (95% CI 55.3–77.7) and 68 (98% CI 58.7–73.3) degrees were associated with minimal DJD in the lower lumbar spine of women and men respectively, and were therefore considered ‘optimal’. This optimal lordotic angle was 73 (95% CI 58.8–87.2) degrees in older men.ConclusionsBoth hypo- and hyper-lordosis correlate with DJD in the lumbar spine, particularly in women and in older men. These findings may well be of relevance to spinal pain management and spinal rehabilitation.
Highlights
Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain
We found that 19.7, 17.2 and 13% of cumulative DJD (ALDI) scores in younger women, older women, and older men respectively, could be explained by Cobb angle (CA) values (Table 1)
The correlation between CA values and DJD scores was interrogated at each individual level of the lumbar spine (Table 2)
Summary
Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Degenerative joint disease (DJD) in the spine, known as osteoarthritis (OA) affects approximately 80% of the population aged 40 and above [1] It has a complex association with chronic low back pain [2] and amounts to a significant health burden. Even though the etiology and pathogenesis of DJD is in need of further investigation, several risk factors for this condition have been identified These factors include: abnormal or excessive joint loading [3, 4] for example as. It is plausible that significant changes from the ‘optimal’ degree of lumbar lordosis could overload spinal joints and influence development or progression of DJD Should this be the case, a correlation would exist between increasing degrees of both hypo- and hyper-
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