Normal Pediatric Lumbar Lordosis: Measurement of Magnitude and Age of Maximum Development Using Three Radiographic Techniques

Background: A retrospective measurement of lumbar lordosis (LL) in normal supine lateral lumbosacral spine radiographs of 27 children aged 0.04–14.00 years. Measurement of the LL may aid in the early diagnosis and management of some pediatric conditions before irreversible neurologic change occurs. They include spondylolisthesis (congenital or acquired); achondroplasia and muscular dystrophies are less common. The sagittal radiographic lumbar lordotic angle is poorly documented in normal pediatric population. Objective: To evaluate the magnitude and age of maximum development of the normal pediatric LL using three different radiographic techniques. Methods: Ferguson (for lumbosacral angle [LSA]), Cobb (for Cobb angle) and tangential radiologic assessment of LL (for TRALL angle) were the methods used. Data were analyzed with SPSS statistics version 20.0 (Chicago, IL, USA). P < 0.05 was considered significant. Results: LSA varied from 15° to 62°, Cobb angle 15–65° and TRALL angle 20–46°. The mean (standard deviation) of LSA, Cobb, and TRALL angles were 35.8 (10.3)°, 35.6 (13.7)°, and 32.3 (7.3),° respectively; the 0.95 confidence interval for the LSA was 27.6–44.5°, Cobb angle 27.2–50.7°, and TRALL angle 26.8–40.1°. Each angle showed no significant gender difference. The major part of estimated adult LL was gained during the first 5 years of life; the second peak occurred in the 11–14 years age‑group. Conclusion: In children under 15 years, poor management of pathologies affecting LL can cause irreversible neurologic damage arising from spinal deformity.