Normal pediatric lumbar lordosis: Measurement of magnitude and age of maximum development using three radiographic techniques

Abstract

Background: A retrospective measurement of lumbar lordosis (LL) in normal supine lateral lumbosacral spine radiographs of 27 children aged 0.04-14.00 years. Measurement of the LL may aid in the early diagnosis and management of some pediatric conditions before irreversible neurologic change occurs. They include spondylolisthesis (congenital or acquired); achondroplasia and muscular dystrophies are less common. The sagittal radiographic lumbar lordotic angle is poorly documented in normal pediatric population. Objective: To evaluate the magnitude and age of maximum development of the normal pediatric LL using three different radiographic techniques. Methods: Ferguson (for lumbosacral angle [LSA]), Cobb (for Cobb angle) and tangential radiologic assessment of LL (for TRALL angle) were the methods used. Data were analyzed with SPSS statistics version 20.0 (Chicago, IL, USA). P < 0.05 was considered significant. Results: LSA varied from 15° to 62°, Cobb angle 15-65° and TRALL angle 20-46°. The mean (standard deviation) of LSA, Cobb, and TRALL angles were 35.8 (10.3)°, 35.6 (13.7)°, and 32.3 (7.3),° respectively; the 0.95 confidence interval for the LSA was 27.6-44.5°, Cobb angle 27.2-50.7°, and TRALL angle 26.8-40.1°. Each angle showed no significant gender difference. The major part of estimated adult LL was gained during the first 5 years of life; the second peak occurred in the 11-14 years age-group. Conclusion: In children under 15 years, poor management of pathologies affecting LL can cause irreversible neurologic damage arising from spinal deformity.