Loss of Cervical Lordosis

As a practicing Orthopaedic Spine Surgeon,  I often get back x-ray reports indicating “Loss of Cervical Lordosis”.   As most of my patients are highly educated,  they often will read that report, and will come to discuss the finding.  So,  I thought I would share my comments on the topic.

As some of you may know,  Lordosis is the curvature of the spine in the sagittal plane  ( simply stated,  the side view),  by which the front portion of the curve points to the front of the body.    Humans typically have  four curves when viewing the spine from the side.  Going from the head,  the first curve is a lordosis curve from the skull to the lower neck.  Then,  there is a compensatory curvature in the opposite direction (kyphosis) from the lower neck to the upper back.  Then,  there is another Lordosis curve from the upper back to the lower back.  Finally,  in the tailbone,  there is a reverse curve (kyphosis).  When you measure the effects of the four curves when standing,  in general,  you have a situation where the head is then balanced over the pelvis, and the center of gravity of a normal person will be positioned  directly in the center of the body.  With that effect,  when standing straight up,  your body will be balanced over the center of gravity,  and there will not be the forces pulling you, or pushing you in any direction.

But,  when we have irritations of parts of the spine,  it can cause this natural gentle curve to straighten.  Often times,  when people have irritation to the neck muscles,  an x-ray or MRI can show loss of the normal lordosis.

For most normal humans,  without any degeneration of the disks,  fractures,  or symptomatic disk herniations,  these muscle irritations do improve and usually,  the lordosis does return.

But,  if we have progressive disk degeneration, or a break,  or arthritis,  the lordosis may decrease, or reverse permanently over time.

So,  when I review an MRI or x-ray, and I see reversal of lordosis,  it does not necessarily mean it is a new finding.  If the advanced degenerative findings are present,  loss of lordosis is expected.

Other factors to consider when discussing Lordosis,  especially in patients without significant pain,  is a positional nature of loss of lordosis.  X-rays and MRI’s can be taken when lying down.  In that scenario,  the position of the neck can cause the image to look like a loss or reversal of lordosis.

Also,  in relationship to the lumbar spine,  sitting MRI’s often will show a loss of lordosis.

In summary,  loss of lordosis can and usually is associated with irritation of the muscles causing loss of the normal curvature.  Muscle irritations can be caused by disk herniations,  muscle sprains, and fractures.  But,  true structural  permanent loss of lordosis is usually secondary to advanced degeneration,  or structural changes to the bones, and disks of the spine.  In rare instances,  humans can be born with a loss of lordosis.

Last modified: January 24, 2018