Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 1 - Jan/Mar - 2018

Original Article Imprimir 

Páginas 73 a 79


Influence of the age factor in spinal curvatures modification in students between 10 to 16 years old

Influencia del factor edad sobre la modificación de las curvaturas de la columna vertebral en escolares entre 10 y 16 años

Influência do fator idade sobre a modificação das curvaturas da coluna vertebral em escolares entre 10 e 16 anos

Autores: Lucele Gonçalves Lima Araujo1; Vandilson Pinheiro Rodrigues2; Flávio Furtado de Farias3

1. Master's Degree in Program Management and Health Services by the Ceuma University. Adjunct Professor, Department of Morphology, Federal University of Maranhão (UFMA). São Luís, MA, Brazil
2. Doctorate in Dentistry by the Federal University of Maranhão (UFMA). Adjunct Professor, Department of Morphology, Federal University of Maranhão (UFMA). São Luís, MA, Brazil
3. Doctorate in Pathology by the the Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil. Adjunct Professor of Physical Therapy, Federal University of Piauí (UFPI). Parnaíba, PI, Brazil

Correspondência:
Lucele Gonçalves Lima Araújo
Universidade Federal do Maranhão
Departamento de Morfologia
Avenida dos Portugueses, s/n, Bacanga
São Luís, MA, Brasil. CEP: 65080-805
(lucelearaujo@gmail.com)

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Keywords: Growth, spine, adolescent, posture.
Palabra Clave: Crecimiento, columna vertebral, adolescente, postura.
Descritores: Crescimento, coluna vertebral, adolescente, postura.

Abstract:
OBJECTIVE: Investigate the influence of the age factor on the variation of spinal curvatures in students between 10 and 16 years old.
METHODS: A cross-sectional study was carried out with 240 students. Demographic and anthropometric data were collected through a questionnaire. The measurement of the angles of the spinal curves were analyzed through the visual evaluation of photographs by computerized digital method.
RESULTS: In male students it was observed that age advancement was correlated with an increase in the angle of cervical lordosis (R² = 0,34; β = +3,81; P < 0,001), reduction of thoracic kyphosis (R² = 0,23; β = -2,00; P < 0,001) and increased lumbar lordosis (R² = 0,07; β = +1,15; P = 0,013). Among the female students, it was also noticed that age advancement influenced the increase of cervical lordosis (R² = 0.23, β = + 3.47, P <0.001) and reduction of thoracic kyphosis (R² = 0, P = 0.002), however, it showed no influence on the lumbar lordosis variation (R² = 0.00, β = -0.09, P = 0.830).
CONCLUSION: The findings suggest that body growth and development may be potential factors for modifying spinal curvatures in this age group.

Resumen:
OBJETIVO: Investigar la influencia Del factor edad sobre La variación de las curvaturas de La columna vertebral en escolares entre 10 a 16 años.
MÉTODOS: Fue realizado un estudio transversal con una muestra de 240 escolares. Los datos demográficos y antropométricos fueron colectados a través de cuestionario. La mensuración de los ángulos de las curvaturas de la columna vertebral fueron analizados a través de evaluación visual de fotografías por método digital computadorizado.
RESULTADOS: En los estudiantes del sexo masculino se observó que el avance de la edad presentó correlación con el aumento del ángulo de lordosis cervical (R2 = 0,34; ß = +3,81; P < 0,001), reducción de la cifosis torácica (R2 = 0,23; ß = -2,00; P < 0,001) y aumento de lordosis lumbar (R2 = 0,07; ? = +1,15; P = 0,013). Entre los escolares del sexo femenino, se notó que el avance de la edad también influenció en el aumento de lordosis cervical (R2 = 0,23; ß = +3,47; P < 0,001) y reducción de la cifosis torácica (R2 = 0,05; ß = -0,92; P = 0,002), sin embargo, no presentó influencia en la variación de lordosis lumbar (R2 = 0,00; ß = -0,09; P = 0,830).
CONCLUSIÓN: Los hallazgos sugieren que el crecimiento y desarrollo corporal puede ser un factor potencial para la modificación de las curvaturas de la columna vertebral en esta franja etaria.

Resumo:
OBJETIVO: Investigar a influência do fator idade sobre a variação das curvaturas da coluna vertebral em escolares entre 10 a 16 anos.
MÉTODOS: Foi realizado um estudo transversal com uma amostra de 240 escolares. Os dados demográficos e antropométricos foram coletados através de questionário. A mensuração dos ângulos das curvaturas da coluna vertebral foi analisada através de avaliação visual de fotografias por método digital computadorizado.
RESULTADOS: Nos estudantes do sexo masculino observou-se que o avanço da idade apresentou correlação com o aumento o ângulo da lordose cervical (R² = 0,34; β = +3,81; P < 0,001), redução da cifose torácica (R² = 0,23; β = -2,00; P < 0,001) e aumento da lordose lombar (R² = 0,07; β = +1,15; P = 0,013). Entre os escolares do sexo feminino, notou-se que o avanço da idade também influenciou no aumento da lordose cervical (R² = 0,23; β = +3,47; P < 0,001) e redução da cifose torácica (R² = 0,05; β = -0,92; P = 0,002), no entanto, não apresentou influência na variação da lordose lombar (R² = 0,00; β = -0,09; P = 0,830).
CONCLUSÃO: Os achados sugerem que o crescimento e desenvolvimento corporal pode ser um fator potencial para a modificação das curvaturas da coluna vertebral nesta faixa etária.

INTRODUCTION

The maintenance of the harmonic balance in body posture presupposes the incidence of a minimal overload of musculoskeletal structures related to the spine in order to obtain maximum functional efficiency. Disturbances in this condition may favor the development of functional or structural postural changes during the growth and development phase of children and adolescents1-3. Surveys conducted in several countries have revealed a high prevalence of postural changes in children and adolescents4-7.

Due to the accelerated growth of the musculoskeletal components, physiological variations can occur at the angles of the curvatures of the spine during childhood and adolescence8. The first five years of life and the age group between 11 and 14 years represent the peak periods for modifying the lumbar lordosis angles9. Thus, changes in sagittal alignment of the spine around growth outbreaks may play an important role in the initiation and progression of postural disorders10. Therefore, it is important to evaluate and monitor the development of spinal morphology for the early detection of possible changes and predisposing conditions, aiming at adopting educational, preventive and professional interventions when necessary11.

Previous studies have already evaluated the configuration of the spine profile in young individuals10,12-15. However, none of these studies addressed the changes in cervical lordosis angles, thoracic kyphosis and lumbar lordosis, categorized by sex using a linear regression model. This information may help in understanding the biomechanics involved in spinal development and in the etiopathogenesis of deformities in the 10-16 age group. Therefore, the objective of the present study is to estimate the influence of age increase on the variation of spinal curvatures in a group of schoolchildren.


METHOD

This cross-sectional study was conducted at the University College of the Federal University of Maranhão-COLUN from May to June 2015. The research protocol was previously approved by the Research Ethics Committee of the Ceuma University (Opinion no. 44770615.8.0000.5084/2014 ). The legal guardians and the students were informed about the research objectives and procedures and, after science, those responsible signed the Free and Informed Consent Form (TCLE) and the students signed the Free and Informed Consent Term (TALE).

Students of both genders, aged between 10 and 16 years, were included in the sample. Exclusion criteria included the presence of congenital and / or traumatic postural alterations, with motor disorders, with cognitive disorders such as Autism and Down Syndrome and known gestation.

For the sample calculation, the formula was used for simple random sample, adopting the following parameters: total of students between 10 and 16 years of age of both genders, enrolled in COLUN in 2015 (n = 643), sampling error of 5 %, 95% confidence level, and the prevalence of the 50% interest variable, a measure used to maximize sample size. Therefore, the minimum number required for the study was 240 students. Research participants were randomly selected using a random number table to avoid sampling bias.

The information on demographic characteristics was obtained from a semi-structured questionnaire elaborated and filled out by the researchers. The anthropometric variables weight, height and body mass index [weight (kg) / height (m) ²] were measured through the use of an electronic digital scale with a capacity of up to 150kg and an accuracy of 100g, and with a stadiometer, 1mm and accuracy of 0.5cm. In the stadiometer, schoolchildren stood erect, barefoot, their upper limbs hanging over their bodies, their heels, their backs touching the vertical rod, and their head touching the horizontal bar, and looking forward.

The measurement of the angles of the spinal curvatures was performed using an instrument adapted from the method of Yi et al.16. To measure spinal angles (cervical lordosis, thoracic kyphosis and lumbar lordosis), small Styrofoam balls were prepared with double-sided adhesive tape and used as markers. The curvature of cervical lordosis was measured through an angle formed by the tragus of the ear, seventh cervical vertebra (C7) and acromion of the scapula, the acromion being the vertex of the angle. The curvature of the thoracic kyphosis was measured by the angle formed by the acromion of the scapula, the seventh thoracic vertebra (T7) and the first lumbar vertebra (L1), with L1 the vertex of the angle. While the curvature of the lumbar lordosis was quantified through the angle formed by the first lumbar vertebra (L1), anterior superior iliac spine (ESAS), and major trochanter of the femur, the EIAS being the vertex of the angle.

Photographs were taken of the students in the static orthostatic position in the right lateral view, barefoot, with their feet slightly united and parallel to each other, flexed elbows and forearms supported on the upper abdomen, and hair attached when necessary to allow visualization of the curvature of the cervical region. The students were instructed to keep their eyes open, looking at the horizon and in silence during the clinical examination. The photographs were recorded in front of a banner type symmetry - transparent plastic screen on white background - Fisiobras, with the aid of a Canon Power Short SX30IS type camera equipped with a 14 megapixel CCD sensor - measures 1/2 to 33 inches at 3.0m, a tripod with a height of 1m at a 90° angle, on a flat surface to ensure horizontality, positioned at a distance of 3m from the school. The angles of the spinal curvatures were analyzed by digital method using the features of the Corel DRAW Graphics Suite, version X7.

The error of the method was calculated using the Dahlberg formula to ensure reproducibility and concordance of the intra-examiner for the measurement of the vertebral column angles. For this purpose, 25 photographs were randomly selected from the sample of the present study and analyzed in two moments with a 10 day interval, obtaining an error level of 0.5º.

The data were analyzed by the statistical program SPSS (version 17.0). The dependent variables represented the angles of cervical lordosis, thoracic kyphosis, lumbar lordosis and height, weight and BMI. The independent variable was age. The descriptive statistics of the variables were performed through measures of frequency, mean and standard deviation. The distribution of age groups among male and female schoolchildren was analyzed by the chi-square test. The normality of the numerical variables was analyzed using the Lilliefors test. After this procedure, a linear model was constructed to estimate the influence of age on anthropometric and angular measures. In this last analysis, the coefficients of determination (R2) and regression (β) were measured. The level of significance was 5%.


RESULTS

A total of 240 students were evaluated in the present study, where the sample distribution by age and sex is expressed in Table 1. The majority of the sample was female (67.1%) and the ages with the highest percentage of participants were 15 years (19.2%), 10 years (17.1%) and 11 years (16.3%). Male and female samples did not differ in age composition (P = 0.380).




Table 2 presents the measurements concerning the anthropometric data and the analysis of the influence of the age factor on these variables. Among boys, it was observed that age influenced the increase in weight (R2 = 0.54, β = +5.46, P <0.001), height (R2 = 0.63, β = +0, 05, P <0.001), BMI (R2 = 0.17, β = +0.67, P <0.001). Among the female schoolchildren, it was observed that the advancement of age also influenced the increase of all anthropometric data: weight (R2 = 0.46, β = +3.97, P <0.001), height (R2 = 0.46, β = +0.03, P <0.001), BMI (R2 = 0.25, β = +0.89, P <0.001).




While Table 3 expresses the measures of central tendency, dispersion and variation of the spinal curvatures in the age range of 10 to 16 years among the evaluated students. It was also noted that the increase in age was correlated with an increase in the angle of cervical lordosis (R2 = 0.34, β = +3.81, P <0.001), reduction in thoracic kyphosis (R2 = 0.23, β = P <0.001) and lumbar lordosis increased (R2 = 0.07, β = +1.15, P = 0.013). Regarding the angular measurements, the increase in age in girls, in the same age group mentioned above, had an effect on the increase of cervical lordosis (R2 = 0.23, β = + 3.47, P <0.001), reduction of kyphosis (R2 = 0.05, β = -0.92, P = 0.002), and had no influence on lumbar lordosis (R2 = 0.00, β = -0.09, P = 0.830).




These results suggest that the age increment influenced the alteration of the values of the anthropometric measures and the curvatures in the vertebral column. The advancement of age was a factor that contributed to the increase of measures of weight, height and BMI, as effect of growth in this age group in both genders.


DISCUSSION

In both genders, there was an increase in the angle of cervical lordosis from 10 to 16 years, leading to a change in the alignment of the spine with the acquisition of the anterior most position of the head. Abelin-Genevois et al.17 concluded that the increase in cervical lordosis during the growth phase is mainly due to changes in the skull-cervical orientation, such as the angle formed by the occipital bone and the C2 vertebra, while the global cervical angle (C1- C7) remains stable. This fact may explain the findings of the present study, since cervical lordosis was measured using a point in the head region (ear tragus).

In the present study, a reduction in the angle of the thoracic kyphosis with advancing age was noticed, where a more posterior inclination of the thoracic segment was observed in the sample. Schlösser et al.10 also observed a reduction in thoracic kyphosis during the pubertal growth spurt, such as differences in the inclination of the T6 and T7 vertebrae according to the growth stage. In addition, in the present study sample, a male tendency to have a higher thoracic kyphosis angle was observed in all the studied age groups when compared to the female sex, thus determining a more ventral inclination posture. A similar finding was found by Wang et al.12 who revealed, in an X-ray study, earlier inclinations in the thoracic vertebrae in male subjects aged 10 to 18 years. It is important to note that variations in angulations in the thoracic segment may be correlated with changes in the angles of cervical lordosis17 and lumbar lordosis18.

Another finding of the present study was the linear growth of the lumbar lordosis angle only in males in the studied age group, with tendency to lumbar rectification. Cil et al.15 revealed that lumbar lordosis increases during growth, however the establishment of its curvature is determined at earlier stages. In addition, girls begin their period of pubertal growth about 2 years earlier than boys19. Thus, the absence of linear variation in the lumbar lordosis angle observed in this study in the female sex may have occurred due to the earlier establishment of its position. In addition, Graup et al.20 found a higher prevalence of rectification of lumbar curvature among male adolescents.

Some important points of the present study should be highlighted. The use of a non-invasive methodology reduces the accuracy that would be obtained through an evaluation by imaging tests. However, this did not expose schoolchildren to ionizing radiation, and allowed the reduction of the cost of the study, besides representing a method that can be easily used for the early diagnosis of possible postural alterations. It is also worth noting that the distribution of the variable sex in the age groups in the sample evaluated was statistically similar, making the groups comparable. Studies with longitudinal designs and with the inclusion of schoolchildren fewer than 10 years are necessary to investigate the variations of spinal curvatures in earlier age groups.


CONCLUSION

The findings of the present study suggest that changes in the angles of spinal curvatures occur during the 10 and 16 years of age. Regarding the variations in the curvature of the spine, the data revealed that chronological age in males influenced the increase of cervical and lumbar lordosis angles and the reduction of thoracic kyphosis angle. While in the female, the growth in this age group, influenced in the increase of the angle of the cervical lordosis and reduction of the thoracic kyphosis, without effect on the variation of the lumbar lordosis angle.

These results reinforce the need to follow the postural development of schoolchildren, aiming at the early detection of alterations of the vertebral column, besides the adoption of educational and preventive measures as prevention of the acquisition and aggravations of these disorders.


ACKNOWLEDGMENTS

To the Board of Directors and to the professors of the University College of the Federal University of Maranhão who assisted in the logistics of data collection, to those responsible and those who accepted to participate in the study.


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