Straightening of the lumbar lordosis means the low back has less of its normal forward curve on imaging. A 2017 meta-analysis found that people with low back pain tend to have less lumbar lordosis than healthy controls, with the clearest difference in people whose pain came with disc herniation or degeneration. That is an association. Whether lost lordosis causes pain, results from it, or simply travels with it is not settled. Patients in Charlotte often see the phrase on an MRI report, and the position of the scan matters as much as the word.
What the Meta-Analysis Found
A Korean group pooled 13 observational studies of 796 people with low back pain and 927 healthy controls, all with lordosis measured on imaging (Chun, Spine J 2017). Across all studies, the pain groups tended to have a smaller lumbar lordotic angle, though the studies were heterogeneous. In six age-matched studies, the difference was consistent, with a standardized mean difference of minus 0.33. In five studies of patients with disc herniation or degeneration, the difference was larger, minus 0.94. Age, pain severity, and the underlying condition explained much of the variation between studies.
The authors described a strong relationship between low back pain and decreased lordosis, particularly against age-matched controls. Because every included study was observational, the analysis cannot show which came first.
Position Changes the Reading
A lumbar MRI is taken lying down. A standing X-ray is taken under the body's weight. At a Charlotte spine center, supine MRI missed 28% of spondylolisthesis levels seen on standing radiographs (Segebarth, J Spinal Disord Tech 2015). Alignment findings, including lordosis, can differ between the two positions. A straightened lordosis on a supine MRI is not the same measurement as lordosis on a standing film. Muscle spasm during the scan can also flatten the curve.
Beyond the Back
In a community study of 245 middle-aged and older adults, a lower lumbar lordosis angle and poorer sagittal balance were associated with symptoms of gastroesophageal reflux, along with medication count and weaker back muscles (Imagama, Eur Spine J 2012). That finding applies to older adults with sagittal deformity, not to a young adult with a straight back on one MRI.
How I Evaluate It
When an MRI report says straightening of the lordosis, I take a standing lateral X-ray before drawing conclusions, measure the curve with a named method, and look at whether the exam points to a disc or other structural source. The alignment finding guides the questions. It is rarely the answer by itself.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read the published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient by Dr. Justin Dick, DC.
Frequently Asked Questions
What does straightening of the lumbar lordosis mean?
It means the low back has less of its normal forward curve on imaging. It often appears on MRI reports.
Is a straight lower back linked to back pain?
A meta-analysis of 13 studies found people with low back pain tend to have less lumbar lordosis, especially with disc herniation or degeneration (Chun, Spine J 2017). The studies were observational and cannot show cause.
Can an MRI show a straightened lordosis that is not really there?
MRI is taken lying down, and position changes alignment. A standing X-ray measures lordosis under load.
Is lumbar lordosis related to acid reflux?
In older adults, lower lumbar lordosis and poorer sagittal balance were associated with reflux symptoms in one community study (Imagama, Eur Spine J 2012).
How does Dr. Justin Dick, DC evaluate a straightened lumbar curve?
Dr. Justin Dick, DC in Charlotte, NC takes a standing lateral X-ray, measures the curve with a named method, and checks whether the exam points to a structural source.
Where can I get a lumbar alignment evaluation in Charlotte, NC?
Dr. Justin Dick, DC, CLEAR Institute Senior Fellow and CNMT, ARRT(N)(CT), sees patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Wy, Ste 103, Charlotte, NC 28278, phone 980-368-0766.
Sources and Evidence Tiers
- Chun SW, Lim CY, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J. 2017;17(8):1180-1191. PMID 28476690. LinkEvidence tier: Systematic review and meta-analysis of observational studies
- Segebarth B, Kurd MF, Haug PH, Davis R. Routine upright imaging for evaluating degenerative lumbar stenosis: incidence of degenerative spondylolisthesis missed on supine MRI. J Spinal Disord Tech. 2015;28(10):394-397. PMID 25353204. LinkEvidence tier: Retrospective cohort
- Imagama S, Hasegawa Y, Wakao N, Hirano K, Hamajima N, Ishiguro N. Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people. Eur Spine J. 2012;21(11):2149-2157. PMID 22370926. LinkEvidence tier: Cross-sectional community study (245 subjects)
About the author. Dr. Justin Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as a field doctor for Life, Sherman, and Palmer chiropractic colleges. ORCID: 0009-0001-2794-2159.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Research by Dr. Justin Dick, DC
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Wy, Ste 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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