Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers

Marcel Dreischarf, Laia Albiol, Antonius Rohlmann, Esther Pries, Maxim Bashkuev, Thomas Zander, Georg Duda, Claudia Druschel, Patrick Strube, Michael Putzier, Hendrik Schmidt, Marcel Dreischarf, Laia Albiol, Antonius Rohlmann, Esther Pries, Maxim Bashkuev, Thomas Zander, Georg Duda, Claudia Druschel, Patrick Strube, Michael Putzier, Hendrik Schmidt

Abstract

Background: The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging.

Methods and findings: A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20-75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20-29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE.

Conclusions: During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.

Conflict of interest statement

Competing Interests: Except of Antonius Rohlmann and Esther Pries, all authors of this manuscript have no conflict of interest. None of them have any relationships to products or companies mentioned in or related to the subject matter of the article being submitted. None of the authors have any pertinent financial relationships, such as consultancies, stock ownership or other equity interests or patent-licensing arrangements for any product or process mentioned in the submission. Only Antonius Rohlmann was a consultant of the Epionics Medical GmbH and Esther Pries is a scientific adviser of the Epionics Medical GmbH. However, this does not influence the results of the present study and does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Epionics SPINE system with the…
Figure 1. Epionics SPINE system with the positions of the Epionics segments S1–S12.
On average, the lumbar lordosis is covered by the first six segments (shown in red). Middle: Schematic sketch of the definition of the determined segmental angle is shown for a single exemplary sensor unit S2.
Figure 2. Mean values of the total…
Figure 2. Mean values of the total lumbar lordosis (top), total range of flexion (middle) and total range of extension (bottom) in all four investigated age groups for the whole cohort (grey columns).
The red lines represent males and the blue lines females. Error bars represent the standard deviation.
Figure 3
Figure 3
Mean values of the segmental lordosis for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in segmental lordosis for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohorts. (C): Relative change in segmental lordosis for the Epionics segments S1 to S6 between the oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of lordosis that the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between the oldest and youngest cohorts.
Figure 4. Age-related postural adaptations of the…
Figure 4. Age-related postural adaptations of the 12 Epionics segments between the oldest and youngest age cohorts for females (left) and males (right).
Figure 5
Figure 5
Mean values of the segmental range of flexion (RoF) for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in the segmental RoF for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to a value of ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohort. (C): Relative change in the segmental RoF for the Epionics segments S1 to S6 between oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of the RoF the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between the oldest and youngest cohorts.
Figure 6
Figure 6
Mean values of the segmental range of extension (RoE) for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in the segmental RoE for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohort. (C): Relative change in the segmental RoE for the Epionics segments S1 to S6 between the oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of the RoE the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between oldest and youngest cohorts.

References

    1. Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The importance of spinopelvic parameters in patients with lumbar disc lesions. International orthopaedics 26:104–108.
    1. Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O’Brien M (2005) The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine 30:S27–34.
    1. Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. European Spine Journal 16:1459–1467 doi:10.1007/s00586-006-0294-6.
    1. Strube P, Hoff EK, Perka CF, Gross C, Putzier M (2012) Influence of the Type of the Sagittal Profile on Clinical Results of Lumbar Total Disc Replacement After a Mean Follow-up of 39 Months. Journal of spinal disorders & techniques. doi: 10.1097/BSD.0b013e31827f434e.
    1. Pellet N, Aunoble S, Meyrat R, Rigal J, Le Huec JC (2011) Sagittal balance parameters influence indications for lumbar disc arthroplasty or ALIF. Eur Spine J 20 Suppl 5647–662 doi:10.1007/s00586-011-1933-0.
    1. Intolo P, Milosavljevic S, Baxter DG, Carman AB, Pal P, et al. (2009) The effect of age on lumbar range of motion: a systematic review. Manual therapy 14:596–604 doi:10.1016/j.math.2009.08.006.
    1. Boden SD (1996) The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. The Journal of bone and joint surgery 78:114–124.
    1. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, et al. (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. The Journal of bone and joint surgery 87:260–267 doi:10.2106/JBJS.D.02043.
    1. Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358.
    1. Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in an asymptomatic Greek population. Spine 23:700–4 discussion 704–5.
    1. Nourbakhsh MR, Moussavi SJ, Salavati M (2001) Effects of lifestyle and work-related physical activity on the degree of lumbar lordosis and chronic low back pain in a Middle East population. Journal of spinal disorders 14:283–292.
    1. Lang-Tapia M, España-Romero V, Anelo J, Castillo MJ (2011) Differences on spinal curvature in standing position by gender, age and weight status using a noninvasive method. Journal of applied biomechanics 27:143–150.
    1. Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618.
    1. Tsuji T, Matsuyama Y, Sato K, Hasegawa Y, Yimin Y, et al. (2001) Epidemiology of low back pain in the elderly: correlation with lumbar lordosis. Journal of orthopaedic science 6:307–311 doi:10.1007/s0077610060307.
    1. Korovessis P, Stamatakis M, Baikousis A (1999) Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients. Journal of spinal disorders 12:131–137.
    1. Takeda N, Kobayashi T, Atsuta Y, Matsuno T, Shirado O, et al. (2009) Changes in the sagittal spinal alignment of the elderly without vertebral fractures: a minimum 10-year longitudinal study. Journal of orthopaedic science 14:748–753 doi:10.1007/s00776-009-1394-z.
    1. Milne JS, Lauder IJ (1974) Age effects in kyphosis and lordosis in adults. Annals of human biology 1:327–337.
    1. Schwab F, Lafage V, Boyce R, Skalli W, Farcy J-P (2006) Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976) 31:E959–67 doi:10.1097/01.brs.0000248126.96737.0f.
    1. Hansson T, Bigos S, Beecher P, Wortley M (1985) The lumbar lordosis in acute and chronic low-back pain. Spine 10:154–155.
    1. Hammerberg EM, Wood KB (2003) Sagittal profile of the elderly. Journal of spinal disorders & techniques 16:44–50.
    1. Amonoo-Kuofi HS (1992) Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging. Acta anatomica 145:373–377.
    1. Tüzün C, Yorulmaz I, Cindaş A, Vatan S (1999) Low back pain and posture. Clinical rheumatology 18:308–312.
    1. Lin RM, Jou IM, Yu CY (1992) Lumbar lordosis: normal adults. Journal of the Formosan Medical Association 91:329–333.
    1. Stagnara P, De Mauroy JC, Dran G, Gonon GP, Costanzo G, et al. (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342.
    1. Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. European Spine Journal 11:80–87.
    1. Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, et al. (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. European Spine Journal 15:415–422 doi:10.1007/s00586-005-0984-5.
    1. Janssen MMA, Drevelle X, Humbert L, Skalli W, Castelein RM (2009) Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine 34:E826–32 doi:10.1097/BRS.0b013e3181a9fd85.
    1. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353.
    1. Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. European Spine Journal 20 Suppl 5578–585 doi:10.1007/s00586-011-1924-1.
    1. Janik TJ, Harrison DD, Cailliet R, Troyanovich SJ, Harrison DE (1998) Can the sagittal lumbar curvature be closely approximated by an ellipse? Journal of orthopaedic research 16:766–770 doi:10.1002/jor.1100160620.
    1. Batti’e MC, Bigos SJ, Sheehy A, Wortley MD (1987) Spinal flexibility and individual factors that influence it. Physical therapy 67:653–658.
    1. Sullivan MS, Dickinson CE, Troup JD (1994) The influence of age and gender on lumbar spine sagittal plane range of motion. A study of 1126 healthy subjects. Spine 19:682–686.
    1. Consmüller T, Rohlmann A, Weinland D, Druschel C, Duda GN, et al. (2012) Velocity of lordosis angle during spinal flexion and extension. PloS one 7:e50135 doi:10.1371/journal.pone.0050135.
    1. Trudelle-Jackson E, Fleisher LA, Borman N, Morrow JR, Frierson GM (2010) Lumbar spine flexion and extension extremes of motion in women of different age and racial groups: the WIN Study. Spine 35:1539–1544 doi:10.1097/BRS.0b013e3181b0c3d1.
    1. Bible JE, Simpson AK, Emerson JW, Biswas D, Grauer JN (2008) Quantifying the effects of degeneration and other patient factors on lumbar segmental range of motion using multivariate analysis. Spine 33:1793–1799 doi:10.1097/BRS.0b013e31817b8f3a.
    1. Troke M, Moore AP, Maillardet FJ, Cheek E (2005) A normative database of lumbar spine ranges of motion. Manual therapy 10:198–206 doi:10.1016/j.math.2004.10.004.
    1. Van Herp G, Rowe P, Salter P, Paul JP (2000) Three-dimensional lumbar spinal kinematics: a study of range of movement in 100 healthy subjects aged 20 to 60+ years. Rheumatology 39:1337–1340.
    1. Dvorák J, Vajda EG, Grob D, Panjabi MM (1995) Normal motion of the lumbar spine as related to age and gender. European Spine Journal 4:18–23.
    1. McGregor AH, McCarthy ID, Hughes SP (1995) Motion characteristics of the lumbar spine in the normal population. Spine 20:2421–2428.
    1. Taylor WR, Consmüller T, Rohlmann A (2010) A novel system for the dynamic assessment of back shape. Medical engineering & physics 32:1080–1083 doi:10.1016/j.medengphy.2010.07.011.
    1. Consmüller T, Rohlmann A, Weinland D, Druschel C, Duda GN, et al. (2012) Comparative evaluation of a novel measurement tool to assess lumbar spine posture and range of motion. European Spine Journal 21:2170–2180 doi:10.1007/s00586-012-2312-1.
    1. Guermazi M, Ghroubi S, Kassis M, Jaziri O, Keskes H, et al. (2006) [Validity and reliability of Spinal Mouse to assess lumbar flexion]. Annales de réadaptation et de médecine physique: revue scientifique de la Société française de rééducation fonctionnelle de réadaptation et de médecine physique 49:172–177 doi:10.1016/j.annrmp.2006.03.001.
    1. National Research Council: Diet and Health. Implications for Reducing Chronic Disease Risk. (1989). Washington D.C.: National Academy Press.
    1. Mac-Thiong J-M, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35:E1193–8 doi:10.1097/BRS.0b013e3181e50808.
    1. Troke M, Moore AP, Maillardet FJ, Hough A, Cheek E (2001) A new, comprehensive normative database of lumbar spine ranges of motion. Clinical rehabilitation 15:371–379.
    1. Schröder J, Braumann KM, Reer R (2014) [Spinal form and function profile: reference values for clinical use in low back pain]. Der Orthopäde 43:841–849 doi:10.1007/s00132-014-2316-0.
    1. Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. European Spine Journal 7:99–103.
    1. Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. Journal of spinal disorders & techniques 18:40–47.
    1. Mac-Thiong J-M, Labelle H, Berthonnaud E, Betz RR, Roussouly P (2007) Sagittal spinopelvic balance in normal children and adolescents. European Spine Journal 16:227–234 doi:10.1007/s00586-005-0013-8.
    1. Schwab F, Lafage V, Patel A, Farcy J-P (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833 doi:10.1097/BRS.0b013e3181a13c08.
    1. Stokes IA, Bevins TM, Lunn RA (1987) Back surface curvature and measurement of lumbar spinal motion. Spine 12:355–361.
    1. Adams MA, Dolan P, Marx C, Hutton WC (1986) An electronic inclinometer technique for measuring lumbar curvature. Clinical biomechanics (Bristol, Avon) 1:130–134 doi:10.1016/0268-0033(86)90002-1.

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