title: Influence of lumbar curvature and rotation on forward flexibility in idiopathic scoliosis.
abstract: BACKGROUND
  Lumbar spine facet joints are arranged sagittally and mainly provide forward flexibility. Rotation of the lumbar vertebral body and coronal plane deformity may influence the function of lumbar forward flexibility. We hypothesize that the more advanced axial and coronal plane deformity could cause more limitation on forward flexibility in patients with idiopathic scoliosis.
  
  
  METHODS
  Between January 2011 and August 2011, 85 patients with adolescent idiopathic scoliosis were enrolled in this study. The proximal thoracic, major thoracic, thoracolumbar/lumbar (TL/L), and lumbar (L1/L5) curves were measured by Cobb's method. Lumbar apical rotation was graded using the Nash-Moe score. Lumbar forward flexibility was measured using the sit and reach (S and R) test. Statistical analysis was performed using one-way analysis of variance (ANOVA), Spearman's and Pearson's correlation coefficients.
  
  
  RESULTS
  The mean age was 16.1 ± 2.84 years. The mean proximal thoracic, major thoracic, TL/L, and L1/L5 curves were 17.61° ± 8.92, 25.56° ± 11.61, 26.09° ± 8.6, and 15.10° ± 7.85, respectively. The mean S and R measurement was 25.56 ± 12.33 cm. The magnitude of the TL/L and L1/L5 curves was statistically positively related to vertebral rotation (r(s) = 0.580 and 0.649, respectively). The correlation between the S and R test and both the TL/L and L1/L5 curves was negative (r(p) = -0.371 and -0.595, respectively). Besides, the S and R test also demonstrated a significant negative relationship with vertebral rotation (rs = -0.768).
  
  
  CONCLUSIONS
  In patients with idiopathic scoliosis, spinal deformity can diminish lumbar forward flexibility. Higher lumbar curvature and rotation lead to greater restriction of lumbar flexion.
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Kao
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, College of Medicine Chang Gung University, Taoyuan, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Chia-Hsieh
authors.initials: CH
authors.lastname: Chang
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D012600:Scoliosis / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D055815:Young Adult