How Doctors Diagnose and Treat Lordosis

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Physical Examination
 A thorough physical examination reveals a lot about the health and general fitness of the patient. The physician will want to know when the curvature was first noticed, past progression, and other related symptoms the patient experiences. The exam provides a baseline from which the physician can measure the patient's progress during treatment. The physical exam may include:

1. Palpation determines spinal abnormalities by feel.

2. Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation. Asymmetry is also noted.

Neurologic Evaluation
A neurological evaluation includes an assessment of the following symptoms: pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes.
Doctor with Patient, doing an examinationDoctor with Patient, showing x-ray results.Radiographic (X-Rays)
The patient stands to reveal the entire length of the spine when PA (posterior/anterior, or back and front) and Lateral (side) x-rays are taken. Side bending AP x-rays are sometimes used to evaluate spinal flexibility. An MRI may be ordered if the spinal cord has been compromised (or suspected).

Further, the Cobb Angle Method may be used to measure the lordotic curve in degrees using a standard full-length AP x-ray.

Non-Surgical Treatment
Non-surgical conservative treatment measures may include:

1. Analgesics and anti-inflammatory medication.

2. Physical therapy enabling the patient to build strength, flexibility, and increase range of motion. The therapist may provide a customized home exercise program.

3. Bracing may be used control curve progression in adolescents.

4. Reduction of body weight to ideal.

5. Surgery may be considered if the lordotic curve is severe with neurologic involvement.

Spine Surgery
Surgical intervention is considered if the lordotic curve is severe, when neurologic involvement exists, or non-surgical conservative treatment has failed to provide relief. A spine surgeon decides which surgical procedure and approach (anterior/posterior, front or back) is best for the patient. His decisions are based on the patient's medical history, symptoms, and radiographic findings. A variety of surgical treatment options are utilized. You should discuss what is best for your condition with your spine surgeon.

Whether the treatment course is conservative or surgical, it is important to closely follow the physician and/or physical therapist's instructions. Discuss any concerns about activity restrictions. They will be able to suggest safe alternatives. Physical therapy may be incorporated into the treatment plan to build strength, flexibility, and increase range of motion. The therapist may provide the patient a customized home exercise program. If the patient undergoes spine surgery, written instructions and prescriptions for necessary medication are given prior to release from the hospital. The patient's care continues during follow-up visits with their surgeon.

Commentary by Harry N. Herkowitz, MD

Most problems related to lordosis occur when the normal lordotic curve or sway is lost. This results in poor posture and a forward tilt. As people age, some loss of lordosis occurs. It is important to maintain regular aerobic exercise along with abdominal strengthening and spine flexibility in order to keep a good posture.

Updated on: 08/21/18
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What Is Lordosis?
Harry N. Herkowitz, MD
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What Is Lordosis?

Swayback is often caused by lordosis; an abnormal inward curve of the lumbar spine.
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