Lordoz – a physiological or pathological bend of a backbone at which its camber is turned kpered. Physiological it is observed at all people in lumbar and cervical department of a backbone. Pathological usually settles down in the same departments, but differs from physiological in bend degree. In rare instances pathological it is formed in chest department of a backbone. Can develop or because of damage of vertebras and muscles of a back (at tumors, malformations, inflammatory processes, contractures etc.), or owing to pathology of coxofemoral joints (the congenital or acquired dislocation, an anchylosis in vicious situation, sgibatelny contractures) as the compensatory mechanism for balance deduction. It is shown by violation of a bearing and back pains. Treatment of a lordoz can be both conservative, and quick.
Lordoz (from Greek lordos – bent, round-shouldered) – a physiological or pathological curvature of a backbone in the perednezadny direction with camber, the turned kpereda. Physiological it is normal formed on the first year of life. Pathological can develop at any age owing to the congenital or acquired pathology of vertebras, coxofemoral joints, muscles of a back, buttocks and hips. Is followed by pains and violation of a bearing. In hard cases can complicate work of internals. Treatment of a lordoz is more often conservative. At the expressed pathology and/or progressing of a pathological lordoz operation can be required.
Normal the human backbone has 4 curvatures: two lordoz (lumbar and cervical) and two kifoz (sacral and chest). All of them are located in the perednezadny (saggitalny) direction. Side curvatures (scoliosis) normal should not be.
The first signs of physiological kifoz and lordoz are found right after the birth. However at babies they are expressed poorly. Bends become expressed when the child begins to stand and go, that is, to the termination of the first year of life. And finally anatomical structure of a backbone is formed by 16-18 years when there is a closing of bone zones of growth. Nevertheless, pathological can arise both at children and teenagers, and at adults. Change of a form and the size of vertebras, and other pathological processes in some departments of the musculoskeletal device becomes the reason of its development in various cases both.
At a pathological lordoz a number of characteristic changes is usually observed. Vertebras are displaced kpered, their bodies fanlikely disperse. In forward departments depression of bone structure and expansion of intervertebral disks is noted. Awned shoots next to the struck department of vertebras are condensed and approach. If pathological arises at children's or young age, the deformation of a thorax which is followed by squeezing and malfunction of bodies of a chest cavity develops. Deformations of other parts of a body can be also observed. At the same time the earlier appeared , the listed changes are expressed more brightly.
Taking into account localization allocate two main forms of a lordoz:
- Cervical department of a backbone.
- Lumbar department of a backbone.
Taking into account the causes distinguish:
- Primary which develops owing to various pathological processes arising directly in a backbone.
- Secondary which has compensation character and arises because the body tries to adapt to maintenance of balance in not physiologic conditions for it.
Taking into account a form allocate:
- Physiological .
- Superfluous pathological ().
- Straightening of a bend ().
Taking into account a possibility of return of a body to normal situation distinguish:
- Unstable at which the patient can by conscious effort straighten a back.
- Partially fixed at which limited changes of a bend angle are possible.
- Fixed at which return of a body to normal situation is impossible.
Secondary pathological can arise owing to a sgibatelny contracture of a coxofemoral joint, an anchylosis (immovability) of a coxofemoral joint, pathological or congenital dislocation of a hip, system diseases of the bone and muscular device, cerebral spastic paresis of the lower extremities, poliomyelitis with damage of muscles of pelvic area and the lower extremities, and also pregnancies. In the latter case is temporary and disappears after the child's birth. At all listed states the center of gravity of a body is displaced forward and to keep balance, the person is bent in a waist.
To number of the contributing factors which increase probability of development of a lordoz and under certain conditions can become the cause of this pathology, violation of a bearing, excess weight also treats with adjournment of a large amount of fat on a stomach and sharp growth at children's and teenage age.
At children and teenagers secondary compensatory usually has mobile character and can decrease or disappear at elimination of the reason which caused it. It is long existing at adult patients becomes fixed, and the backbone bend in such cases does not change even after elimination of provocative factors.
Change of a bearing (usually at violation of normal curvature of one department of a backbone there is more or less expressed curvature and other its departments), increased fatigue and pains in the struck department of a backbone which amplify after physical activity or stay in an inconvenient pose is among the general manifestations of a pathological lordoz. Restriction when performing certain physical actions is observed. At the expressed lordoz the diseases of heart, lungs, kidneys, a stomach and intestines caused by violation of normal interposition and squeezing of appropriate authorities can develop.
Depending on the nature of pathological changes it can be observed several options of violation of a bearing which are followed by reduction or increase in a lordoz.
The Kruglovognuty back (kifolordotichesky bearing) is followed by increase in all bends. Lumbar and chest are strengthened. Legs are in the provision of easy reextension or easy bending in knee joints. Shovels stick out, shoulders are given, are raised, the stomach acts forward. The head can be also put a little forward kpered.
Round back (kifotichesky bearing). Significant increase in a chest kifoz at the corresponding reduction of a lumbar lordoz is observed. The center of body weight at such violation of a bearing is displaced kzad therefore the person slightly bends legs when standing and walking to level this imbalance. The ducking forward and reduction of a tilt angle of a basin is noted. Shoulders are given, are raised, shovels stick out. Hands hang down several kpereda from a trunk. The breast which sank down a stomach acts forward.
Plano-concave back. Flattening of a cervical lordoz and reduction of a chest kifoz is noted. Lumbar is normal or it is increased. Basin at such bearing the center of weight is displaced kzad, knees of a pererazognuta or are a little bent. The head is hung, the chin "looks" down. Shovels stick out, a thorax hollow.
Flat back. All natural bends of a backbone are reduced, flattening of a lumbar lordoz is especially strongly expressed. The tilt angle of a basin is reduced. Shovels stick out, the thorax is displaced kpered, the lower part of a stomach sticks out.
Most often, speaking about a pathological lordoz, mean strengthening of a lumbar lordoz (lumbar ) at which the kifolordotichesky bearing is observed. Such change of a shape of a backbone develops at the majority of secondary pathological lordoz.
Taking into account the nature of pathological process allocate several types of a giperlordoz which differ on symptomatology and a clinical current.
Fixed and unstable lumbar strengthened which develops owing to the processes causing the shift of the center of gravity of a body of a kpereda. Can arise at deformation of a thorax owing to a spondilolistez, back dislocation and a sgibatelny contracture of a hip, and also a sharp curvature of a backbone with formation of a costal hump as a result of the expressed scoliosis or bone tuberculosis. The beginning can be both sharp, and gradual. Character of a current and clinical symptomatology are defined by degree of a lordoz.
Razgibatelny lumbar and coxofemoral rigidnost. Develops at young patients with the normal state of a backbone. It is formed as a protective pose at various volume and slipchivy processes in the field of nervous backs. Can arise at an arakhnoidita of a spinal cord, radiculitis and some other diseases. Superfluous in this case appears owing to a bezbolevy contracture lumbar and gluteuses. The beginning is gradual. A characteristic sign of such lordoz is the sliding gait. Usually proceeds favorably.
Fixed lumbar strengthened which arises owing to volume processes in lumbar department of a backbone. Most often such develops at disk hernias. Usually the first symptoms of a lordoz appear in the middle age. The beginning can be both gradual, and sharp (at break of a jellylike kernel). Lordoz is followed by a razgibatelny contracture lumbar and gluteuses. In attempt to overcome a contracture and to give to a body normal situation there is a sharp morbidity in the area coxofemoral joints. Stretching symptoms are observed. Irradiation (spread of pain on the back surface of a hip and shin) are noted seldom. There are no violations of sensitivity and movements. Current of a lordoz usually adverse. Over time the decompensation develops, there are neurodystrophic changes in soft fabrics. The expressed, long pains are characteristic.
Because of violation of a normal form of a backbone at all types of a lordoz there is a pathological redistribution of load of bones, sheaves and muscles. Sheaves pererastyagivatsya, muscles constantly are in a condition of the increased tension. As a result slackness, weakness, bystry fatigue develops. At resistant, it is long the existing lordoz there can be following complications:
- Pathological mobility of vertebras.
- Multiple ladder (reduction of stability of intervertebral disks).
- Losses of disks.
- Hernias nuclei pulposi.
- Psoit (inflammatory process in a podvzdoshno-lumbar muscle).
- The deforming arthrosis of joints of a backbone.
The diagnosis of a pathological lordoz is exposed on the basis of survey and data of a X-ray analysis. During survey the doctor estimates position of a body, natural to the patient, and feature of a bearing, and also carries out a number of special tests to establish whether it is fixed and whether it is followed by neurologic violations. Besides, the doctor palpates muscles of a back and investigates bodies of a chest cavity.
At suspicion on a pathological lordoz without fail do a backbone X-ray analysis in a direct and side projection. To gain an impression about degree of a lordoz carry out side roentgenograms at the maximum extension and bending of a back. At the same time the radiologist by measurements estimates mobility of a backbone in the perednezadny plane (normal, reduced, strengthened). Besides, the doctor reveals violations of structure and a shape of vertebras, and also their interpositions.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Hyper - and hypo - lordoz orthopedists and vertebrolog are engaged in treatment. The main objective of therapy is elimination of the reason which caused pathological . During treatment kineziterapevtichesky rehabilitation and orthopedic procedures is also carried out. To patients appoint manual therapy, medical massage and physiotherapy exercises. Carrying proofreaders of a bearing (bandages or corsets) is sometimes shown. At primary pathological lordoza expeditious treatment with the subsequent rehabilitation is carried out.