What are the treatment options for lumbar lordosis?

Treatment Options for Lumbar Lordosis

The most effective treatment for lumbar lordosis includes corrective exercises that focus on strengthening paraspinal and abdominal muscles, which have been shown to significantly improve lumbar lordotic angles and reduce functional disability. 1

Conservative Management (First-Line Treatment)

• Supervised exercise programs focusing on strengthening paraspinal and abdominal muscles provide better support for the spine and are recommended as initial treatment 2
• Corrective exercises have demonstrated a moderate positive effect (SMD = 0.550, p < 0.001) on lumbar lordotic angle correction in patients with abnormal lumbar lordosis 1
• Lumbar stabilization exercises are more effective than conventional conservative treatments for improving both functional disability and lumbar lordosis angles 3
• Extension traction methods can increase lumbar lordosis by 7-11° over 10-12 weeks of treatment (30-36 sessions) with benefits maintained at 6-month follow-up 4
• Proper patient positioning with flexed hips and knees at 90° helps reduce physiological lumbar lordosis during diagnostic procedures 5

Orthotic Devices

• Lumbar lordosis braces can be beneficial by:
  • Providing compression in the lumbar region
  • Correcting sagittal plane spine balance
  • Improving postural control of the lumbar spine 6
• These braces act as a reminder to maintain physiological lumbar curvature and have been shown to improve balance strategies in patients with lumbar pain 6

Surgical Options (For Refractory Cases)

• Surgical intervention should be considered only after failure of conservative management for 3-6 months and when significant neurological symptoms or progressive instability are present 2
• For patients with lumbar lordosis abnormalities and associated stenosis without significant instability, decompression alone may be sufficient 2
• Lumbar fusion is recommended for patients with chronic low back pain due to degenerative disc disease that is refractory to conservative treatment 5
• Posterolateral fusion (PLF) is recommended for patients with lumbar stenosis and associated degenerative spondylolisthesis who require decompression 5
• Pedicle screw fixation should be considered as an adjunct to lumbar PLF in cases with spinal instability or kyphosis 5

Special Considerations

• Careful attention to sagittal balance is essential when performing spinal fusion procedures, as loss of lumbar lordosis (flat-back syndrome) is a potential complication that can lead to inability to stand erect and upper back pain 7
• The presence of neurological deficits, especially progressive ones, should prompt more urgent surgical evaluation 2
• When performing diagnostic imaging such as DXA scans, positioning aids (such as foam blocks under the knees) help flatten the lumbar lordosis and improve accuracy of measurements 5

Treatment Algorithm

1. Begin with supervised corrective exercises focused on core strengthening for 10-12 weeks 1, 3
2. Consider adding extension traction methods if initial exercise therapy shows insufficient improvement 4
3. Evaluate for orthotic support with a lumbar lordosis brace if postural control remains problematic 6
4. For persistent symptoms despite 3-6 months of conservative care, consider surgical evaluation 2
5. Surgical options should be based on the presence of:
   • Associated stenosis or spondylolisthesis (decompression with or without fusion) 5
   • Significant instability (decompression with fusion and possible instrumentation) 2
   • Refractory pain without stenosis (lumbar fusion may be appropriate) 5