Curvatures of the Spine

Describe primary curvatures.

Kyphotic, posterior

Describe secondary curvatures.

Lordotic, anterior

Where are primary/kyphotic/posterior curvatures found?

Thoracic and pelvic (sacrococcygeal) regions

Where are secondary/lordotic/anterior curvatures found?

Cervical and lumbar regions

What are curvatures named according to?

Direction of the convexity of the curve

What kind of curves can be found in the spine?

Anterior, posterior, or lateral

In the earliest stages of fetal development, what direction do the curves face?

Posteriorly

What does the posterior fetal curve persist in adults as?

Thoracic and pelvic curves

In what segments is the thoracic curve found?

T2-T12

What creates the thoracic primary curvature?

Posterior body height greater than anterior body height

Where does the pelvic curve extend to and frm?

L5-S1 articulation to tip of coccyx

What creates the posterior pelvic curve?

Greater superior to inferior dimensions of sacral segments

What are the secondary curvatures known as?

Anterior/compensatory

When are secondary curves detected?

Fetal development

When are secondary curvatures apparent?

Postnatal period

What do secondary curvatures allow for in humans?

Erect posture

When does cervical lordosis begin?

Late in intrauterine life

When does cervical lordosis become apparent?

When infant lifts head from prone position

In what age period does cervical lordosis become apparent?

3-4 months of age

When is the cervical lordosis further accentuated?

9 months - child begins to sit upright

What maintains the adult cervical curve?

Increased anterior dimensions of IVD

What is the least distinct of the spinal curves?

Cervical lordosis

What happens with the cervical lordosis with age?

Increases significantly

Where does the upper primary cervical curve extend from?

Occiput to axis

What kind of curve is found in the lower cervical region?

Lordotic

Where is the lower cervical curve foudn?

Inferior aspect of C2 and below

In what age group is the lack of typical cervical lordosis common in?

Children and adolescents younger than 17

What may a lack of cervical lordosis in adults be a sign of?

Ligamentous injury

Anterior cervical muscular hypertonicity

Hyperplastic articular pillars

When does the lumbar lordosis develop?

9-18 months after birth

What muscles pull the lumbar spine erect to achieve position necessary for walking?

Erector spinae

What does the erector spinae muscles create?

Posterior concavity in lumbar region

Where does the lumbar lordosis extend from?

T12 to lumbosacral articulation

Where is the lumbar lordosis prominent from?

L3-L5/S1

In what sex is the lumbar lordosis more common in?

Females

What maintains the lumbar lordosis?

shape of IVD and vertebral bodies

In what direction are the lumbar IVDs taller?

Anterior

What happens to the lumbar lordosis when traction forces are applied?

Reduced

In infants, what position are the zygopophysis in?

Coronal

In adults, what position are the zygapophysis in?

Sagittal

When does movement of facet orientation begin?

6 months

When does sagittal position is first identified?

18 months

What does facet movement factor into?

Development of posture

Ability to walk

Transference of weight from VB to zygopophysis

Formation of lumbar lordotic curvature

In what direction does the nucleus pulposis shift in annulus fibrosis at the L4 level?

Posterior

At what level is there a unique progression in lumbar curve development where there is a posterior shift of NP in AF?

L4

What compensates for variations in lumbar lordosis?

Cervical lordosis

What is the effect of sitting in an erect position on lumbar and cervical lordosis?

Lumbar - increase

Cervical - decrease

What is the effect of lumbar forward flexion on lumbar and cervical lordosis?

Lumbar - decrease

Cervical - decrease

What is the effect of lumbar extension on lumbar and cervical lordosis?

Lumbar - increase

Cervical - decrease

Where is there a slight lateral curve?

Upper thoracic region

When does the lateral thoracic curvature appear?

After 6 years of age

In what regions is a lateral curvature usually observed in?

Thoracic and lumbar regions

In right-handed people, what side is the convexity of the curve on?

Right

What can cause deviations in lateral curvature?

Asymmetrical muscle use/tone

What condition involves a deviation of a curve toward posterior aspect?

Kyphosis

What can cause kyphosis?

• Poor posture

• DDD

• Arthritis

• Osteoporosis

• Trauma

  • Developmental

What is the angle of the natural thoracic kyphotic curve?

20-45 degrees

What is the name of the condition involving an increased thoracic curve greater than 50 degrees?

Hyperkyphosis

What are the other names for kyphosis?

Humpback

Hunchback

Roundback

What kind of abnormalities are characteristic of kyphosis?

Postural or structural

T/F: In kyphosis, most cases cause few problems; no treatment required.

True - occasionally back brace and exercises required

What is characteristic of severe cases of kyphosis?

Painful

Breathing issues

Surgical intervention required

What are the three types of hyperkyphosis?

1) Postural kyphosis

2) Scheuermann’s kyphosis

3) Congenital kyphosis

What is an example of hypokyphosis?

Straight-back syndrome

What is the most common type of kyphosis?

Postural kyphosis (1 in 10 kids)

How is postural kyphosis noticeable during adolescence?

Poor posture or slouching

What bias is involved with postural kyphosis?

Females, typically around age 12-17

Which type of kyphosis is NOT associated with severe structural abnormalities?

Postural kyphosis

How is postural kyphosis corrected?

Patient stands up straight

T/F: The curve does NOT progress in postural kyphosis.

True

T/F: Postural kyphosis usually causes pain and other issues.

False - usually does NOT

What does the typical backpack weigh?

more than 30% of the weight of the child

What are the symptoms of a heavy backpack on children?

Sore back and shoulders

Poor posture

Compressed IVD

Abnormalities in spinal curvature

What is the recommended safety load of a backpack?

10-15% of a child’s weight

In what percentage of adolescents is Scheuermann’s kyphosis found?

0.4-8.3%

What kind of abnormality is Scheuermann’s kyphosis?

Structural

What is the cause of Scheuermann’s kyphosis?

Unknown!

Which type of kyphosis involves disruption of cartilaginous endplates and epiphyseal rims?

Scheuermann’s kyphosis

What is the result of the wedge-shaped vertebral bodies in Scheuermann’s kyphosis?

decrease IVD space anteriorly, creates exaggerated curvature

At what age does Scheuermann’s kyphosis begin?

age 10-12

Why does Scheuermann’s kyphosis begin at age 10-12?

Epiphyseal rims are secondary center of ossification

When and why do kids with Scheuermann’s kyphosis seek treatment?

age 12-15

aching back pain paired with increased thoracic kyphosis

What treatments are used in Scheuermann’s kyphosis?

Bracing spine in extension

Palliative treatment for pain/discomfort

Exercises

What kind of kyphosis is present at birth?

Congenital kyphosis

What causes congenital kyphosis?

Vertebrae do not form properly or may fuse together

T/F: Congenital kyphosis worsens with age.

True

What is the treatment for congenital kyphosis?

Surgical intervention at a young age

What other birth defects often accompany congenital kyphosis?

Heart/kidney issues

Neurological symptoms

What neurological symptoms are found with congenital kyphosis?

Weakness and numbness in legs

What is the name for the condition in which the thoracic kyphosis is almost completely absent?

Straight (flat) back syndrome

What is the result of straightening of thoracic kyphosis?

Narrowing of anterior-posterior dimensions of thoracic age

What cardiac issue is associated with the heart being forced to shift position in straight back syndrome?

Kinks in great vessels

What conditions are associated with straight back syndrome?

Systolic heart murmurs

Distorted cardiac silhouette on X-ray

Simulate organic heart disease

Idiopathic mitral valve prolapse

Which condition associated with straight back syndrome can be life-threatening?

Idiopathic mitral valve prolapse

What kind of condition is lordosis?

Anterior-bending condition

What are the causes of lordosis?

Posture

Overweight

Trauma

Surgery

Pregnancy

Hip problems

What is the typical cervical lordotic curve?

20-40 degrees

What condition involves a cervical lordotic curve greater than 40 degrees?

Hyperlordotic

What condition involves a cervical lordotic curve less than 20 degrees?

Hypolordotic

What is the typical lumbar lordotic curve angle?

40-60 degrees

What groups are more commonly affected by lordosis abnormalities?

Adults over 50

Kids going through growth spurts

Pregnancy