Development of thoracic spine kyphosis and lumbar spine lordosis in the growing child from birth to adulthood: protocol for a systematic review
Al-Allaf, Omar Mostafa, Omar Ezzat Saber Henegan, Nicola Austin-Davies, Holly Gardner, A
Al-Allaf, Omar
Mostafa, Omar Ezzat Saber
Henegan, Nicola
Austin-Davies, Holly
Gardner, A
Affiliation
The Royal Orthopaedic Hospital NHS Foundation Trust; The Dudley Group NHS Foundation Trust; University of Birmingham
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Publication date
2025-08-25
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Abstract
INTRODUCTION: Thoracic kyphosis, a posterior curvature of the thoracic spine and lumbar lordosis, an anterior curvature of the lumbar spine, are essential components of spinal alignment that facilitate a biomechanically efficient upright stance. Understanding the normal growth of the spine and its constituents, especially during periods of rapid growth, is important as deviations from normal growth are thought to be initiating factors of spinal conditions such as scoliosis. While in the coronal plane the spine is straight, there is variability in the reported normative values of sagittal spinal shape, reported in the paediatric population. This variability may well represent the range of normality allowing for population differences of ethnicity and sex, but could also be attributed to differing imaging techniques and measurement methods. The aim of this systematic review is to investigate the normative values for thoracic kyphosis and lumbar lordosis between birth and adulthood. The review's findings should enhance the understanding of the development of the spine and aid in establishing the range that results from differences in techniques of measurement and imaging modalities used.
METHODS AND ANALYSIS: This review protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Inclusion criteria are participants aged 18 years or less without pain or spinal pathology, such as scoliosis, any spinal or thoracic surgery and any other medical conditions that could affect spinal growth and development. The review will consider studies reporting serial quantitative measurements of thoracic kyphosis and lumbar lordosis. Inclusion will be limited to studies published in English. The PubMed, Embase, Ovid MEDLINE and Cochrane Library databases will be searched. Following Cochrane guidance, a dual reviewer system will be used where both reviewers will screen 20% of titles and abstracts to confirm concordance, and then one reviewer will screen the remaining articles. During full-text screening, one reviewer will review all the full-text articles while the second reviewer will review all the articles excluded by the first reviewer, with a third reviewer being involved to resolve any discrepancies. A risk of bias assessment will be performed on the identified studies. The data extracted will be analysed through meta-analysis if it proves feasible, synthesising continuous data such as the size of the kyphosis and lordosis, with further subcategorisation by sex and ethnicity as appropriate. Correlation coefficients will be used to analyse relationships between variables, and I values will be used to assess heterogeneity. Alternatively, if a meta-analysis is not possible, the data will be presented narratively using the synthesis without meta-analysis guidelines. An overall statement of confidence in the cumulative results and findings will be provided using the Grading of Recommendations, Assessment, Development and Evaluation system.
ETHICS AND DISSEMINATION: Ethical approval is not required for this study as no original data will be collected. The findings will be disseminated to academic audiences through peer-reviewed journals and conference presentations.
PROSPERO REGISTRATION NUMBER: CRD42024502782.
Citation
Al-Allaf O, Mostafa OES, Henegan N, Austin-Davies H, Gardner A. Development of thoracic spine kyphosis and lumbar spine lordosis in the growing child from birth to adulthood: protocol for a systematic review. BMJ Open. 2025 Aug 25;15(8):e095947. doi: 10.1136/bmjopen-2024-095947
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