Disc Versus Vertebral Body Contribution to Lumbar Lordosis in Asymptomatic Subjects

Study Design. Retrospective study of a multicentric prospective database. Objective. This study aimed to describe the relative contribution of vertebral bodies versus discs to lumbar lordosis and its variation with age and pelvic incidence. Summary of Background Data. While studies sought to determine the physiological magnitude and distribution of lumbar lordosis, data regarding its anatomical composition is lacking. Methods. This study included healthy volunteers with full-body stereoradiographs in free-standing position, without lumbosacral transitional vertebra, or age under 18. The following parameters were analyzed: age, sex, pelvic incidence (PI), and lumbar lordosis (LL). Posterior heights and sagittal Cobb angles between the upper and lower endplate for each lumbar disc and each vertebral body were measured from L1 to S1. Ratios of contribution to LL were calculated for each disc and vertebral body. The cohort was divided into four age groups and four PI groups. Results. Six hundred forty-five subjects were included, mean age was 37.6±16.3, 51% of females. There was a significant decrease in total lumbar disc lordosis with age (−48.9±9.7° to −42.9±10.2°), occurring in lower LL. Vertebral bodies were significantly more kyphotic in Seniors than Youngs (−8.9±8.4° vs. −5.0±9.4°, P=0.03), driven by a significant increase in kyphosis of L1 and L2 bodies. Vertebral body contribution to LL significantly increased between groups as PI increased, from a median of 8.0% to 20.5% (P<0.001). This decrease in disc contribution in favor of vertebral bodies mainly took place in lower LL. Conclusions. This study highlights the importance of vertebral contribution to lumbar lordosis, ranging from 8% to 21% among PI groups. Lumbar lordosis decreased with aging through decreased disc lordosis in the lower lumbar spine and increased body kyphosis in the upper lumbar spine. These results may help surgeons in the assessment of sagittal alignment and the selection of operative technique to achieve surgical correction.