Development of the Lumbar Lordotic Curvature in Children From Age 2 to 20 Years

In Brief Study Design. Cross-sectional retrospective study. Objective. The purpose of this study was to provide data for the normal values of the lumbar lordotic curvature and segmental angles throughout childhood and to explore the relative contribution of the vertebral bodies and intervertebral discs to the developing lordosis during childhood. Summary of Background Data. Although early detection of spinal abnormalities such as hyper lordosis or scoliosis is important for preventative intervention, published data regarding normal lordosis development is sparse. The lumbar lordotic curvature is formed by the wedging of the lumbar vertebral bodies and of the intervertebral discs, but there are no data to indicate how these 2 components changes during childhood development. Methods. Spinal angle parameters were measured on midsagittal reformatted images from 210 abdominal computed tomographic scans of children aged 2 to 20 years. Four different angles were measured: the lordosis angle, the body wedge angle (B), the total segmental angle (S), and the intervertebral disc angle (D). Measurements B, S, and D were taken for each of the 5 lumbar segments. Measurements B and D were used to calculate ΣB, the sum of the lumbar L1–L5 body angles; and ΣD, the sum of the lumbar L1–L5 intervertebral disc angles. Computed tomographic scans were divided into 6 groups according to patients' ages. Results. The lordosis angle increased from 30° ± 6° in the 2- to 4-year-old group to 44° ± 9° in the 17- to 20-year-old group. The ΣB slightly decreased (less lordotic wedging) with age, whereas the ΣD increased significantly with age. Conclusion. Our results indicate that the lordosis angle continues to develop at least until 14 to 16 years of age and that this increase is the result of the increased lordotic wedging of the intervertebral discs. Level of Evidence: N/A The lordosis angle increases by 14° during childhood. This increase is due to marked changes in the wedging of the intervertebral discs. The results of this study can be used as a reference frame for detecting early abnormalities in the lumbar lordotic curvature of children.