Christine - YOU ARE RIGHT!

Losing normal lumbar lordosis raises risk.

NEW ORLEANS -- Loss of normal lumbar spinal curvature may predispose women to pelvic organ prolapse, Dr. T. Fleming Mattox reported at the annual meeting of the Society of Gynecologic Surgery.

In a prospective study of spinal curvature among 363 women who presented with complaints of urinary incontinence or pelvic organ prolapse (POP), Dr. Mattox and his colleagues at Greenville (S.C.) Hospital System found that those patients who had lost normal lumbar lordosis had a 3.2-fold increased prevalence of POP.

"Correct pelvic support involves bony structures as well as muscular and pelvic connective tissue components. Yet there have been very few studies looking at the bony structures. We wondered whether the spine, particularly lumbar lordosis, plays a role in protecting the pelvic organs from prolapse," Dr. Mattox said.

He and his colleagues used a bendable metal flexi-curve rod to assess spinal curvatures. The instrument is placed against the spine and molded to assume the patient's spinal contour from the seventh cervical to the fifth lumbar vertebrae.

The contour is then transferred to graph paper by tracing the flexi-curve device, a method of assessing spinal curvature.

A total of 92 patients had abnormal lumbar curvatures, and among them loss of lumbar lor-dosis was by far the most common abnormality. Eighty-four of these women (91%) had current or past histories of POP. Compared with women who had normal lumbar curvatures, those with diminished curvature were 3.2 times more likely to have POP.

The severity of the spinal abnormalities also clearly correlated with the severity of the prolapse as measured by a standardized staging system. Among the 72 subjects with stage 0 prolapse, 8(11%) had lost lumbar lordosis; among the 99 at stage 3, 30 women (30%) had lost lordosis.

Age appeared to play a role. Women with clinically significant prolapse were a mean age of 64 years, compared with 60 years among those who did not have POP. There were no other significant demographic variables.

These findings, however, are still preliminary. "It is just an association at this stage. We have not yet bridged the gap between statistical association and causal relationship," Dr. Mattox stressed.

But, he predicted, future research will bear out a direct relationship.

Normal lumbar lordosis is believed to be protective of normal pelvic organ architecture because it would deflect abdominal vector forces that can contribute to the development of prolapse.

When adequate lumbar curvature is lacking, pelvic organs are predisposed to prolapse.

Osteoporosis is probably the underlying pathology involved in the loss of normal lumbar contours, said Dr. Mattox, although this remains to be tested.

If the link among osteoporosis, spinal curvature, and POP is established, it would underscore the need to stem the bone disorder with hormone replacement, calcium, and exercise. "You could argue that not only will [intervening] prevent fractures, but it could also reduce the risk of pelvic prolapse," Dr. Mattox said.

On the other hand, he cautioned, at this point it is also plausible that osteoporosis is not the key and that POP precedes and contributes to the loss of lumbar lordosis.

"We are hoping to get some funding to go forward with this line of research" he added.

COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group

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Sybille