Loss of Lumbar Lordosis: Causes, Imaging Findings, and Clinical Meaning

Loss of lumbar lordosis (straightening of the normal inward curve) is a radiographic finding with multiple etiologies:

Common Causes

• Muscle Spasm/Guarding: Acute back pain → paraspinal spasm flattens curve (reversible).
• Degenerative Disc Disease: Disc height loss reduces lordosis.
• Spinal Stenosis: Postural adaptation to relieve nerve compression.
• Ankylosing Spondylitis: Progressive fusion in flexed posture.
• Post-surgical (e.g., laminectomy): Structural alteration.
• Poor Posture/Chronic Sitting: Adaptive shortening of hip flexors, hamstrings.

Reported Findings Explained

• "Bony alignment preserved": No listhesis, scoliosis, or fracture.
• "Intervertebral spaces preserved": No significant disc space narrowing visible.
• "No fracture": Trauma excluded.

Clinical Significance

Isolated loss of lordosis with preserved alignment/spaces often suggests muscular/postural etiology. Correlate with symptoms. Physical therapy (core strengthening, hip flexor stretching, posture retraining) is first-line.