Roentgenographic analysis of lumbar lordotic dimensions among indigenes of Delta State

Abstract

The spinal column of humans possesses strategically placed concave and convex curves which work in harmony to give an upright posture. The inwardly concave curvature in the lumbar region of the spine is known as the lordosis and it plays a very important role in the formation of the posture of humans. Analysis of the human lordosis is of great importance as it has been shown to be a major factor in the onset of low back pain, and is of great importance in spinal reconstructive surgery, through which some form of repair can be done to the spinal column that has undergone some form of alteration. The present study was carried out to analyse the lumbar lordotic dimensions among indigenes of Delta State. The aim of the study was to find out the average lordotic angle, vertebral body height and intervertebral disc height for the male and female population. The study was also aimed at finding the range for the normal lordotic angles as well as the correlations between these dimensions and the age of an individual. A regression equation was also formulated with which the lordotic angle of an individual can be estimated given the age of that individual. The sample size was 384 individuals (204 males and 180 females) with an age range of 20-60 years. The male population had a mean angle of 59.33±2.45° and the females had a lower mean value of 53.33±2.61°. The study showed males had higher mean values for lumbar vertebra height and intervertebral disc height. A steady increase in the height of the lumbar vertebra and intervertebral disc from the first to the last was observed in this study. This study also showed that a weak negative correlation existed between the age of an individual and the lordotic angle and the vertebral height. Correlations between the age and intervertebral disc height showed a weak positive correlation. A regression formula was derived for estimating the lordotic angle of an individual given the age. This study will be of great importance to medical practitioners and forensic anthropologists in spinal reconstructive surgery and forensic human identification by gender and age. Keywords: Lumbar Spine. Lordosis, Lordotic Angle, Correlation, Regression.

Full text

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1736
ORIGINAL COMMUNICATION
Submitted 8th October 2018. Published online 1st February 2020. To cite: Ojieh U, Ebeye AO. Roentgenographic
analysis of lumbar lordotic dimensions among indigenes of Delta State. Anatomy Journal of Africa. 2020, 9 (1): 1736
– 1743.
ROENTGENOGRAPHIC ANALYSIS OF LUMBAR LORDOTIC
DIMENSIONS AMONG INDIGENES OF DELTA STATE
Ugochukwuka Ojieh, Abimbola Oladunni Ebeye*
*Department of Human Anatomy, Delta State University, Abraka, Nigeria.
Correspondence to Ugochukwuka Ojieh, Synergy Lifeline Consulting, Second Floor, Nicon Insurance
Plaza, Plot 242, Muhammadu Buhari Way, Central Business District, Abuja. Email:
ugoojieh@gmail.com, Phone: 08036988076.
ABSTRACT
The spinal column of humans possesses strategically placed concave and convex curves which work
in harmony to give an upright posture. The inwardly concave curvature in the lumbar region of the
spine is known as the lordosis and it plays a very important role in the formation of the posture of
humans. Analysis of the human lordosis is of great importance as it has been shown to be a major
factor in the onset of low back pain, and is of great importance in spinal reconstructive surgery,
through which some form of repair can be done to the spinal column that has undergone some form
of alteration. The present study was carried out to analyse the lumbar lordotic dimensions among
indigenes of Delta State. The aim of the study was to find out the average lordotic angle, vertebral
body height and intervertebral disc height for the male and female population. The study was also
aimed at finding the range for the normal lordotic angles as well as the correlations between these
dimensions and the age of an individual. A regression equation was also formulated with which the
lordotic angle of an individual can be estimated given the age of that individual. The sample size was
384 individuals (204 males and 180 females) with an age range of 20-60 years. The male population
had a mean angle of 59.33±2.45° and the females had a lower mean value of 53.33±2.61°. The
study showed males had higher mean values for lumbar vertebra height and intervertebral disc height.
A steady increase in the height of the lumbar vertebra and intervertebral disc from the first to the
last was observed in this study. This study also showed that a weak negative correlation existed
between the age of an individual and the lordotic angle and the vertebral height. Correlations between
the age and intervertebral disc height showed a weak positive correlation. A regression formula was
derived for estimating the lordotic angle of an individual given the age. This study will be of great
importance to medical practitioners and forensic anthropologists in spinal reconstructive surgery and
forensic human identification by gender and age.
Keywords: Lumbar Spine. Lordosis, Lordotic Angle, Correlation, Regression.
INTRODUCTION
Proper physique is important for optimal
functionality of the human body. One of the
major determining factors of the physique of
an upright human is the structure of the spinal
column (Farahani et al., 2012, Ambegaonkar et
al., 2014, Been et al., 2014, Been et al., 2017).
The upright posture of humans is constantly
maintained by the spinal and pelvic muscles,
hence weakness in this muscles, lack of proper
exercise and inappropriate push or pull
movements using these muscles will ultimately
lead to body imbalances which culminate in
improper posture (Kendall, 1983, Castillo &
Lieberman, 2015).This upright posture in
humans is as a result of the presence of
characteristic concave and convex curves on
the spinal column. The concave curves, known
as Lordotic curves and are found in the cervical
and lumbar regions of the spine while the
convex curves, called Kyphotic curves and are
found in the thoracic and sacral spinal regions.
The presence of these curves in the spinal
column of an upright man is necessary in the
maintenance of the upright posture as it gives
a great degree of stability to the head and torso
over the lower limbs and allows for proper
https://dx.doi.org/10.4314/aja.v9i1.13

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absorption of loads applied on the spinal
column (Gracovetsky & Iacono, 1987; Farfan,
1995; Gomez-Olivencia et al., 2013; Arsuaga et
al., 2015). They also present him with the
advantages of greater sight, increased speed
and an increased gamut (Bushe-McGregor et
al., 1981). Man can thus easily balance himself
on two feet and use his upper limbs for
functions other than locomotion.
One of the major postural analysis of an
individual is that of his lumbar lordosis. Lumbar
lordosis. Lumbar lordosis is defined to be the
inwardly concave curvature which extends
from the first lumbar vertebrae to the fifth
lumbar vertebrae, formed majorly by the
wedging of the intervetebral discs of each of
these vertebrae and counters the forward
inclination of the sacrum and thus restores the
upward inclination of the spinal column. Of the
five lumbar vertebrae which forms the lordosis,
the last lumbar segment (L5) contributes
almost 40% to overall lordosis while the first
segment (L1) contributes only 5% (Been et al.,
2010).
Lumbar lordotic angle values for humans as
reported by Been et al, (2013) ranges from 30º
to 80º. Values lower than this result in lumbar
hypolordosis and values greater result in
lumbar hyperlordosis. In the African and
Nigerian perspective, studies on lumbar
lordotic angles are evidently deficient and
hence the knowledge of lumbar lordosis among
African populations including Nigerians is
sparse and those available, to the best of our
knowledge have conflicting results (Patrick,
1976, Murrie et al., 2003, Legaye, 2007,
Oyakhire et al., 2013).The general objective of
this study was to study the lumbar lordotic
dimensions among indigenes of Delta State.
MATERIALS AND METHOD
This study was a descriptive cross-sectional
study and was retrospective in nature and
radiographs which were used for this study
were obtained from the archives of a selected
tertiary health institution. The reasons for the
retrospective nature of this study were among
others to avoid the ethical issues of
unnecessary exposure of individuals to
radiation as some individuals, after radiologic
evaluation would have presented pathological
abnormalities and would be ultimately
excluded from the study.
The heterogeneous population was stratified
according to ethnic group into homogenous
subsets of Delta State Indigenes. Elements
were then randomly selected from each of the
subsets in a manner which insured equal
representation of each homogeneous subset.
For this study, 384 digital lateral lumbar
radiographs of individuals between the ages of
18-60 years, were free of any congenital
abnormalities and clearly showed that 5 lumbar
vertebra and the intervertebral discs between
L1 and L5 respectively where used.
Radiographs taken with an Allengers Ceiling
Suspended Static X-Ray Unit were displayed on
a computer monitor screen so as to better
highlight the landmarks from which the
measurements were taken. Measurements
were taken using the Clear Canvas (Version
3.0) software. The Cobb’s method was used to
measure the lumbar lordotic angle on the
radiographs. The vertebral body height and the
intervertebral disc height were measured using
special digital vernier calipers on the Clear
Canvas (Version 3.0) software.
Data collected from the study was subjected to
statistical analysis using the IBM Corp, IBM
SPSS Statistics for Windows, Version 22.0.
Armonk, NY:IBM Corp. Results were analysed
for Descriptive Statistics, Independent Sample
T-test, Pearson Correlation and Regression
equation.

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RESULTS
Results from the study showed that males had
a mean lumbar lordotic angle of 59.35°±2.45
and females and mean lumbar lordotic angle of
53.33°±2.61. Males thus showed higher mean
values than females and this difference was
shown to be statistically significant (p=0.001).
For the five lumbar vertebra, males had steady
higher mean values than females. In every
case
the difference between male and female values
was shown to be statistically significant
(p≤0.05); (Table X). For both males and
females, a steady increase was observed in the
mean values of of the five lumber vertebrae
from L1 to L5 (Figure X).
Table 1. Values for Male and Female Lumbar Lordotic Angles
N = 384
VALUE
MALE = 204
59.35°±2.45
FEMALE = 180
53.33°±2.61
P – Value
0.001
Table 2. Mean values for the five lumbar vertebrae in males and females
L1
L2
L3
L4
L5
MALE
2.89±0.32
3.05±0.29
3.14±0.28
3.25±0.26
3.42±0.26
FEMALE
2.67±0.30
2.84±0.28
2.96±0.28
3.09±0.28
3.26±0.25
P - Value
0.001
0.001
0.001
0.001
0.001
Figure 1. Measurement of Lumbar
Lordotic angle
Figure 2. Measurement of Vertebral body
height
Figure 3. Measurement of Intervertebral
disc height

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Figure 4. Graph showing the steady increase in mean values of the five lumbar vertebrae in males
and females.
The four lumbar intervertebral discs also
showed steady higher mean values in males
than in females and these differences where all
shown to be statistically significant (p≤0.05);
(Table X). Among males and females, it was
observed that the height of the intervertebral
discs increased steadily from the first to the
fourth intervertebral disc.
IVD1
IVD2
IVD3
IVD4
MALE
1.03±0.23
1.23±0.25
1.39±0.24
1.56±0.26
FEMALE
0.97±0.22
1.17±0.19
1.32±0.18
1.49±0.22
P – Value
0.033
0.001
0.002
0.005
Table 3. Mean Values for the four intervertebral discs in males and females.
Figure 5: Graph showing the steady increase in intervertebral disc heights from the first to the fourth in males and females.

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Pearson Correlation tests showed that age had a weak negative correlation with lumbar lordotic angles
and with vertebral body heights. This means that an increase in the age of an individual would lead
to a decrease in the lumbar lordotic angle and lumbar vertebral body height. Conversely, the
correlations between age and the lumbar intervertebral disc height were shown to be weak positive
correlations. This means that an increase in the age of an individual would result in a corresponding
increase in the lumbar intervertebral disc height. (Table X).
Pearson Correlation
Coefficient
Sig.
Age * LLA
-0.149
0.005
Age * L1
-0.770
0.149
Age * L2
-0.140
0.009
Age * L3
-0.155
0.004
Age * L4
-0.179
0.001
Age * L5
-0.138
0.010
Age * IVD1
0.161
0.003
Age * IVD2
0.190
0.001
Age * IVD3
0.121
0.025
Age * IVD4
0.088
0.101
Table 4. Correlations between age and various parameters
Female
Male
Coefficient
Std. Error
Coefficient
Std. Error
Constant (K)
56.857
.880
59.290
.889
B
-.078
.019
.002
.020
Table 5. Regression table
The regression equation formula is given as X = k + bY. Where; X = dependent variable. k = Constant; b = ……; Y =
independent variable; From the table 4.25 above; k = 56.857(females); 59.290 (males); b = -0.078(females); 0.002 (males).
Putting the figures above in the formula, the regression equation for LLA given the age of an individual is; Female X =
56.857 – 0.078Y. Male X = 59.290 + 0.002Y.
DISCUSSION
The study measured the lumbar lordotic angles
of the males and females study population. The
male participants had a minimum angle of
58.70° and a maximum value of 65.80°, with a
mean angle of 59.35±2.45°. Female
participants had lower values with a minimum
value of 39.40° and a maximum value of
58.90°, with a mean angle of 53.33±2.61°.The
results of this study varied from those of
studies by Oyakhire et al., (2013) among
indigenes of Port-Harcourt; Ayad et al., (2013)
among Sudanese; Okpala (2014) in
Southeastern Nigerians; Abdelmonem et al.,
(2014) in Egyptians, all of which showed

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greater lordotic angles values in Females
compared to males. Several factors such as
method of measurements and ethnicity could
have been contributing factors to these
variations.
The height of the five lumbar vertebrae which
forms the lumbar lordosis was also measured
in the course of this study (Tables 4.3- 4.7 and
Figs. 4.3- 4.7). Among the male population the
mean heights of the vertebrae were 2.89±0.32
for L1, 3.05±0.29 for L2, 3.14±0.28 for L3,
3.25±0.26 for L4 and 3.42±0.26 for L5. The
female population showed lower mean values
for heights of the 5 lumbar vertebrae vis.
2.67±0.30 for L1, 2.84±0.28 for L2, 2.96±0.28
for L3, 3.09±0.28 for L4 and 3.26±0.25 for L5.
Among the male and female population a
steady increase in the heights of the vertebrae
was observed from L1-L5 with L5 being the
largest of all (Fig. 4.8).These observation
agreed with those of Busche-McGregor et al.,
(1981) who observed that the fifth lumbar
vertebra was the largest and contributed most
to the lumbar lordosis. A theory also accepted
by Been and Kalichman, 2017.
The heights of the intervertebral discs located
within the lumbar region of the spinal column
were measured among the males and females
with the males showing larger values for the
heights compared to females (Tables 4.8 –
4.11 and Figs. 4-9-4.12).
Among the male population, the heights of the
intervertebral discs were 1.03±0.23,
1.23±0.25, 1.39±0.24 and 1.56±0.26 for the
first, second, third and fourth intervertebral
discs respectively. Among the female
population, the heights of the intervertebral
discs were 0.97±0.22, 1.17±0.19, 1.32±0.18
and 1.49±0.22 for the first, second, third and
fourth intervertebral discs respectively.
The values for the heights of the lumbar
vertebra and their corresponding intervertebral
discs showed that males had a longer lumbar
lordosis than females, a theory that agreed
with the study of Hay et al., (2015).
Independent samples T-test was used to test
for significance of gender differences among all
the variables. The mean difference was
considered to be significant at a level of
P≤0.05.
The difference between the mean Lumbar
Lordotic angle for males and females was
shown to be statistically significant (P=0.001).
These results differed slightly from those of
Oyakhire et al., (2013), Ayad et al, 2013,
Okpala 2014 etc, who though found a
statistically significant difference in lumbar
lordotic angles of both genders, recorded
females as having higher mean values for
lumbar lordotic angles, compared to men.
For the five different lumbar vertebrae (L1-L5)
males had larger mean values in all occasions
and the mean difference between males and
females, when tested, where all statistically
significant (L1=0.001; L2=0.001; L3=0.001;
L4=0.001; L5=0.001). Males also had a
greater mean intervertebral disc height,
compared to the females and the difference
and the difference between the between the
mean intervertebral disc height between males
and females was statistically significant for all
four lumbar intervertebral discs with P values
of 0.03, 0.0, 0.01 and 0.05 for the first to fourth
lumbar intervertebral respectively.
Pearson’s correlation test carried out to find out
the correlation existing between age and
lumbar lordotic angle among the sample
population showed that a weak negative
correlation existed between both variables (-
0.149). This correlation was statistically
significant (P=0.005). This agreed with the
study of Murrie et al., 2003 who stated that
with increasing age there is a decrease of the
lumbar lordotic angle. It however did not agree
with the studies of Youdas et al., 1996 and
Kalichman et al., 2011 who did not find any
correlation between age and lumbar lordotic
angle.
Results from this study also showed a negative
correlation between age and the height of each
of the five lumbar vertebra. This means that an
increase in the age of an individual will
ultimately lead to a decrease in the height of
the lumbar vertebra.
Results however showed weak positive
correlations between age and the height of the

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intervertebral disc among the individuals and in
the case of the fourth lumbar intervertebral
disc this correlation was statistically not
significant. It may be hypothesized that the
positive correlation noticed which means an
increase in age will lead to an increase in
intervertebral disc height is not unrelated to
the negative correlation observed between age
and vertebral height as a decrease in the
vertebral height may be complimented by an
increase in the corresponding intervertebral
disc. This theory though, remains to be
clarified.
A regression equation with which the lumbar
lordotic angle of an individual can be calculated
given the age of the individual was also
developed. Where Female X = 56.857 – 0.078Y
and Male X = 59.290 + 0.002Y, where X stands
for the lumbar lordotic angle of the individual
and Y stands for the age of the individual.
In conclusion indigenes of Delta State, males
have a significantly longer lordosis and a higher
lumbar lordotic angle than the females. This
shorter and steeper curve noticed among the
females could be attributed to various tasks
which they undergo such as carrying of heavy
loads on their heads, carrying of children on
their backs and others which make for a much
deeper curve in the lumbar spine of the
women. This may also explain the higher
incidence of low back pain in men than women
as reported by Oyakhire et al., 2013 as the men
are closer to having a flat back than the
women. Unconfirmed reports in a study by
Stagnara et al., 1982 have also reported that
the steeper curve in women is as a result of the
larger buttock size and more prominent
backward curve in women compared to men.
This occurrence brings about the need for a
compensating forward lean of the lumbar
region. Moore et al., 2014 also stated that the
number of pregnancies a woman may have had
could have an effect on her lumbar lordosis and
he further stated that the new lordosis usually
remains after pregnancy. This could also be
hypothesized as a reason for the steeper
lordosis among the females.
Results from this study showed that among
indigenes of Delta State, normal lordosis
ranges from 30°-70°, a slight variation from
the generally accepted range of 30°-80°. This
variation could be related to factors such as
stature, occupation, and ethnicity.
It is recommended that this kind of research be
carried out on more independent ethnic groups
and if possible, using a prospective approach
as this would give even more concise results.
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