LORDOSIS (lordosis; grech, lordos bent, round-shouldered + - osis) — a rachiocampsis, turned kpered camber.
The backbone of the adult has fiziol, bends: in cervical and lumbar departments of a kpereda — cervical and lumbar L., in chest and sacral department of a kzada — chest and sacral kyphosis (see) owing to what its profile contour forms the wavy line.
Fiziol, cervical L. forms at the child on the first year of postembryonal development that is connected with active deduction of the head in vertical position; it takes all cervical vertebrae and two upper chest, and its top is the share of the V—VI cervical vertebrae. Lumbar L. forms at the child with the advent of function of a pryamostoyaniye and walking; it takes all lumbar, XI and XII chest vertebrae, and its top corresponds to the III—IV lumbar vertebrae.
Patol. L. can be result of increase (hyperlordosis) or reduction of degree fiziol. L. or to be created at the level fiziol, a kyphosis. As independent disease patol. L. almost does not meet as secondary compensatory deformation (compensatory L.) it is observed often. Besides, distinguish the acquired L., arising at various diseases and deformations of a musculoskeletal system, and inborn L., formed at the level of anomalies of development of bodies of vertebrae (see. Backbone ).
Emergence of a compensatory lumbar hyperlordosis is explained by the fact that a backbone, the basin and the lower extremities with hip joints represent uniform system of a support and the movement. Change in one of its links inevitably leads to changes in all system. The most often lumbar hyperlordosis forms as compensatory in the presence of a flexion contracture of a hip joint, napr, at congenital dislocation of a hip (fig. 1) or its anchylosis in the provision of bending at inf. (including tubercular) a coxitis, at the deforming coxarthrosis, at the persons who had poliomyelitis with damage of muscles of the lower extremities and a basin and cerebral spastic paresis of the lower extremities at general diseases of bones and joints, etc. The lumbar compensatory hyperlordosis at these patients is formed in connection with an inclination of a basin and the lumbar vertebrae of a kpereda following it. It is the important adaptive mechanism providing in patol, conditions a vertical axis of a body and an arrangement of the center of gravity in the field of the area of a support. The secondary compensatory hyperlordosis at children and teenagers remains mobile, but at long existence at adults it becomes fixed and can become the reason of restriction of an inclination of the case of a kpereda and the secondary painful phenomena caused osteochondrosis (see), dystrophic changes in intervertebral joints (see. Diskosis ) and in the field of the pulled together acanthas. A bit different mechanism of formation of the acquired hyperlordosis at an inborn and youthful kyphosis (fig. 2), at children with an achondroplasia (fig. 3), a spondiloepifizarny dysplasia, an epiphyseal dysostosis, a cholesteatoma, a spastic cerebral palsy, the torsion spasm and poliomyelitis. In these cases the reason of development of a hyperlordosis is put in the backbone or muscles knowing its function. At an inborn or youthful kyphosis, at children with an achondroplasia, a spondiloepifizarny dysplasia, an epiphyseal dysostosis patol, the kyphosis in the lower chest and upper lumbar vertebrae forms at the level of klinovidno the changed bodies of vertebrae and the narrowed disks. Below a kyphosis kompensatorno bodies of vertebrae are displaced kpered that is the reason of a hyperlordosis. At a siondilolisteza the hyperlordosis is formed owing to the shift of a kpereda of the V lumbar vertebra.
At a spastic cerebral palsy and the torsion spasm, and also at the shell and radicular syndrome connected with a cholesteatoma, the hyperlordosis develops owing to a muscle tension of a back. The cervical hyperlordosis arises at children with a posttraumatic synostosis in back department of a backbone (at a rupture of interspinal and yellow sheaves). At the children who had poliomyelitis at deep paresis of muscles of a front abdominal wall and safe function of long muscles of a back patol, the hyperlordosis also forms.
Smoothness (flattening) fiziol, lumbar L. it is observed at persons with the small patol, a kyphosis forming at the level L. At the same time flattening and fiziol, a chest kyphosis is, as a rule, observed owing to what the backbone becomes straightened (fig. 4). Most often similar deformation arises at a youthful kyphosis due to decrease in height of lumbar disks and decrease in height of bodies of lumbar vertebrae in front departments. Similar mechanism of flattening of lumbar and cervical L. it is observed at a compression fracture of bodies of vertebrae or their synostosis, at destructive processes in lumbar department of a backbone (e.g., tumors, a tubercular spondylitis).
In cervical department the hyperlordosis arises at persons with a hyperkinetic form of paresis, but more often in this department there comes its smoothness, edges comes to light after an injury (an incomplete dislocation, dislocation, a compression fracture of a body of a vertebra) in this connection this smoothness of cervical L. gains important diagnostic value (fig. 5). At the inborn or acquired synostosis of bodies of the II—III cervical vertebrae on site L. the kyphosis as well as at destruction or a compression of bodies of cervical vertebrae can form.
For diagnosis of a hyperlordosis and often for definition of its reason the X-ray analysis of a backbone has the leading value.
The indistinct image of bodies of vertebrae on the roentgenogram in a direct projection at the strengthened L. demands an additional picture in the same projection, but at the changed direction of a path of rays. For receiving a sharp image of upper lumbar vertebrae the central bunch of x-ray emission is centered in the kraniokaudalny direction, and the lower cervical vertebrae — kaudokranialny. Degree of fixity (or mobility) L. it can be defined by a X-ray functional research. For this purpose make pictures of a backbone in a side projection at usual vertical position inspected, and then in a condition of the maximum bending and extension. The objective characteristic of curvature of a backbone is based on the accounting of radiuses of the arches proyektsionno connecting on the side roentgenogram similar points of bodies of vertebrae on their front or back surfaces. The radius of curvature is less, the L is expressed stronger. On the roentgenogram in a direct projection about degree of L. it is possible to judge by the size of discrepancy of the first and rear edge of a body of the I lumbar vertebra (fig. 6). Sometimes at the expressed L. excessive rapprochement of acanthas of lumbar vertebrae at a hyperlordosis can lead to formation between them of a joint and the deforming osteoarthrosis (fig. 7) in it.
Treatment of a hyperlordosis consists in timely elimination of the reason which caused its formation, contractures of a hip joint, its anchylosis in the vicious provision, correction of a kyphosis, stabilization of a backbone at a spondylolisthesis etc.
In a complex of treatment enter to lay down. gymnastics and massage at first in horizontal position and when the patient starts walking — willows vertical. The purpose of gymnastics — strengthening of muscles of a backbone, increase in its mobility.
Prevention of a hyperlordosis: the prevention and early treatment of the deformations leading to its development.
Bibliography: Tager I. A. and Dyachenko V. A. Radiodiagnosis of diseases of a backbone, page 139, M., 1971; Watson-Jones R. Fractures of bones and injury of joints, the lane with English, page 608, M., 1972; Chaklin V.D. Orthopedics, t. 1 — 2, M., 1957; Chaklin V. D. and Abalmasova E. A. Skolioz and kyphosis, page 24, M., 1973, bibliogr.; Ide 1-berger K. Lehrbuch der Ortopadie, S 130 u. a., B. u. a., 1978.
E. A. Abalmasova; S. A. Sviridov (rents.).