• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.20-23
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• 2012

Objective : To compare radiographic analysis on the sagittal lumbar curve when standing, sitting on a chair, and sitting on the floor. Methods : Thirty asymptomatic volunteers without a history of spinal pathology were recruited. The study population comprised 11 women and 19 men with a mean age of 29.8 years. An independent observer assessed whole lumbar lordosis (WL) and segmental lordosis (SL) between L1 and S1 using the Cobb's angle on lateral radiographs of the lumbar spine obtained from normal individuals when standing, sitting on a chair, and sitting on the floor. WL and SL at each segment were compared for each position. Results : WL when sitting on the floor was reduced by 72.9% than the average of that in the standing position. Of the total decrease in WL, 78% occurred between L4 to S1. There were significant decreases in SL at all lumbar spinal levels, except L1-2, when sitting on the floor as compared to when standing and sitting on a chair. Changes in WL between the positions when sitting on a chair and when sitting on the floor were mostly contributed by the loss of SL at the L4-5 and L5-S1 levels. Conclusion : When sitting on the floor, WL is relatively low; this is mostly because of decreasing lordosis at the L4-5 and L5-S1 levels. In the case of lower lumbar fusion, hyperflexion is expected at the adjacent segment when sitting on the floor. To avoid this, sitting with a lordotic lumbar curve is important. Surgeons should remember to create sufficient lordosis when performing lower lumbar fusion surgery in patients with an oriental life style.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.3
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• pp.1834-1839
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• 2019

Background: Lumbar lordosis is a result of muscle shortening and may cause low back pain. Objective: To examine the effects of static and dynamic stretching on lumbar lordosis and low back pain in university students. Stretching is an intervention that can be applied to shortened muscles; however, very few studies have compared the effects of static and dynamic stretching on lumbar lordosis and low back pain. Design: Randomized controlled clinical trial (single-blind) Methods: The 12 selected subjects were randomly assigned static stretching and dynamic stretching groups each containing six students. The subjects in each group performed their respective stretching programs for 17 minutes, 3 times a week for 4 weeks. Lumbar lordotic angle, low back pain, and Oswestry Disability Index (ODI) were measured before and after the intervention. Results: Intragroup comparisons showed significant reductions in lumbar lordotic angle and low back pain in the static stretching group while the dynamic stretching group showed significant decreases in lumbar lordotic angle, low back pain, and ODI. The intergroup comparisons showed significantly greater differences between pre- and post-intervention in lumbar lordotic angle and low back pain in the dynamic stretching group compared to those in the static stretching group while ODI did not show any intergroup difference. Conclusions: The results of this study indicated that, while both static and dynamic stretching helped to reduce the lumbar lordotic angle and low back pain, dynamic stretching was more effective in alleviating lumbar lordotic angle and low back pain compared to static stretching.

• The Journal of Korean Physical Therapy
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• v.24 no.3
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• pp.208-215
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• 2012

Purpose: We attempt to assess the differences in the degree of lumbar lordosis in patients with lower back pain caused by the herniation of the nucleus pulposus and in normal people (divided into male and female groups). Methods: This study was conducted with 14 patients (7 males, 7 females) diagnosed with, and being treated for, lumbar herniated nucleus pulposus and 14 normal people (7 males, 7 females). In order to examine the degree of lumbar lordosis in these subjects, hip flexor lengthening tests were conducted and the lumbar curves were measured in three postures (supine, sitting, and prone) and the results were compared. Results: The measured values of the curves for the standing and prone postures showed statistically significant differences between the normal group and the patient group, between the normal male group and the male patient group, and between the normal female group and the female patient group (p<0.05). Conclusion: The measurement method that uses flexible curve rulers in the standing or prone postures can be usefully utilized in assessing the lumbar lordosis of patients with lumbar herniation of the nucleus pulposus.

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.613-624
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• 2001

Backgroun and purpose: The purpose of this study was to find out the effect of high heel shoes on lumbar lordosis for young ladies. The most of ladies wear high heel shoes at least 4 to 5 days a week. Subjects: Subjects were 30 young ladies age between 20 to 30 years old who go to the Sahm Yook University. Methods: Participants were static standing position with bear feet, tennis shoes. and 6cm high heel shoes each different time. The ankles of subjects were 15 degree plantar flexion with 6cm high heel shoes. Metrecom Skeletal Analysis System v. 3. 10 was used to measure the lordosis of each subject. Results: The angle of the lordosis with high heel shoes showed the significant decrease omparing with the angle of lordosis with bear feet and tennis shoes. The mean difference is 2.57 degree. Conclusion: There is strong relationship between the high of heel with decreasing the lumbar lordosis(p<0.05).

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.1 no.2
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• pp.93-100
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• 2006

Objectives: To invesgate correlation between the scoliotic curve and BMI, cervical lordosis, lumbar lordosis and Ferguson angle in spinal scoliotic patient. Methods: The study was composed of 14 scoliosis patients beyond cobb'a angle $10^{\circ}$ (sample I group) and 15 scoliosis patients over cobb'a angle $10^{\circ}$ (sample II group). The patients were evaluated with X-ray findings of full spine AP and lateral views and statistically analyzed. Results: 1. Sample II group showed a significant decrease in BMI as compared with Sample I group(P<0.05). 2. Scoliotic curve had s negative relationship with $BMI({\gamma}=0.406)$ 3. Scolotic patients had a lower cervical angle than normal man. Conclusion: 1. The larger the scoliotic angle, the lower BMI 2. There are no concemed scoliotic curve and cervical lordosis, lumbar lordosis and Ferguson angle.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• The Journal of Korean Physical Therapy
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• v.13 no.2
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• pp.467-475
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• 2001

The purpose of this study was to evaluate changes of static lumbar lordosis by different heel heights in normal adults and patients with herniation of nucleus pulposus(HNP). The lumbar lordosis was examined while standing on barefoot, on heel support with 4cm heel, and with 8cm heel in 10 normal adults and 10patients with HNP. Standing lumbar lateral view was performed by 20 minutes adaptation with corresponding shoe types. The angle of lumbar lordosis was taken with Wiltse and Winter's method(angles between upper margin of 1 st lumbar body and upper margin of 5th lumbar body). The results of this study were as follow: 1. Significant statistical decrease in lumbar lordosis was observed as heel heights were increased from barefoot to 8cm high heel in normal adults(p<0.05). 2. There were no significant differences in lumbar lordosis according to three different heel heights in patients with HNP(p>0.05). 3. In comparison of barefoot, There were statistically significant decrease in HNP patients compared with normal adults in terms of lumbar lordosis(p<0.05).

• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.33-43
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• 2023

Objective : To compare the outcomes of anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), and transforaminal lumbar interbody fusion (TLIF) in terms of global sagittal alignment. Methods : From January 2007 to December 2019, 141 adult patients who underwent multilevel interbody fusion for lumbar degenerative disorders were enrolled. Regarding the approach, patients were divided into the ALIF (n=23), OLIF (n=60), and TLIF (n=58) groups. Outcomes, including local radiographic parameters and global sagittal alignment, were then compared between the treatment groups. Results : Regarding local radiographic parameters, ALIF and OLIF were superior to TLIF in terms of the change in the anterior disc height (7.6±4.5 mm vs. 6.9±3.2 mm vs. 4.7±2.9 mm, p<0.001), disc angle (-10.0°±6.3° vs. -9.2°±5.2° vs. -5.1°±5.1°, p<0.001), and fused segment lordosis (-14.5°±11.3° vs. -13.8°±7.5° vs. -7.4°±9.1°, p<0.001). However, regarding global sagittal alignment, postoperative lumbar lordosis (-42.5°±9.6° vs. -44.4°±11.6° vs. -40.6°±12.3°, p=0.210), pelvic incidence-lumbar lordosis mismatch (7.9°±11.3° vs. 6.7°±11.6° vs. 11.5°±13.0°, p=0.089), and the sagittal vertical axis (24.3±28.5 mm vs. 24.5±34.0 mm vs. 25.2±36.6 mm, p=0.990) did not differ between the groups. Conclusion : Although the anterior approaches were superior in terms of local radiographic parameters, TLIF achieved adequate global sagittal alignment, comparable to the anterior approaches.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.331-336
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• 2014

Objective : The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods : Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ${\geq}50mm$). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results : The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion : Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.365-371
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• 2012

Objective : To document lumbar lordosis (LL) of the spine and its change during surgeries with the different height but the same angle setting of the anterior cage. Additionally, we attempted to determine if sufficient LL is achieved at different cage heights and to quantify the change in LL during multi-level anterior lumbar interbody fusion (ALIF). Methods : The medical records and radiographs of 42 patients who underwent more than 2 level ALIFs between 2008 and 2009 were retrospectively reviewed. We evaluated 3 parameters seen on lateral whole spine radiographs : LL, pelvic incidence (PI), and sagittal vertical axis (SVA). The mean follow-up time was 28.1 months and the final follow-up radiographs of all patients were reviewed at least 2 years after surgery. Statistical analysis was performed using the paired t-tests. Results : Lumbar lordosis had changed up to 30 degrees immediately and 2 years after surgery (preoperative mean LL, SVA : 22.45 degrees, 112.31 mm; immediate postoperative mean LL, SVA : 54.45 degrees, 37.36 mm; final follow-up mean LL, SVA : 49.56 degrees, 26.95 mm). Our goal of LL is to obtain as much PI as possible, preoperative mean PI value was $55.38{\pm}3.35$. The pre-operative and two year post-surgery follow-up mean of the Japanese Orthopedic Association score were $9.2{\pm}0.6$ and $13.2{\pm}0.6$ (favorable outcome rate : 95%), respectively. In addition, we were able to obtain good clinical outcomes and sagittal balance with a subsidence rate of 22.7%. Conclusion : We were able to achieve sufficient LL, such that it was similar to the PI, utilizing multi-level ALIF with the use of a tall cage with the same angle setting of the cage. We have found out that achieving sufficient lumbar lordosis and sagittal balance require an anterior lumbar cage with high angle and height.