La lordosis cervical en la salud y la enfermedad: Revisión de literatura

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INTRODUCCIÓN

Desde mi graduación en el colegio de quiropráctica (Life Chiropractic College West) en 1994, he dedicado una buena parte de mis 20 años en las trincheras de la clínica y la investigación tratando de entender y mejorar las anomalías de la lordosis cervical en poblaciones de pacientes. Personalmente he estado involucrado en muchas investigaciones desarrollando y comparando la evidencia en busca de una conexión entre la lordosis cervical en la salud humana, la enfermedad y los desórdenes de columna. En el presente artículo, se presenta un breve pero enfocado repaso de la literatura sobre la lordosis cervical; luego se comparan los métodos recomendados de atención en el consultorio y en el hogar con la evidencia disponible.

La Lordosis en el Adulto

La lordosis cervical en el adulto ha recibido considerable atención en la literatura de la columna; en 1996, se reportaron los valores y la forma geométrica tanto promedio como ideal de la lordosis cervical. La lordosis cervical promedio en el adulto es de 34° ± 9° entre las líneas del cuerpo vertebral posterior C2-C7.1 En un documento de seguimiento en 2004, mis colegas y yo2 modelamos la lordosis cervical del adulto (utilizando un método de ajuste de la curva conocido como el error de mínimos cuadrados) como una pieza de un círculo de C2 a T1. Más aún, demostramos diferencias estadísticamente significativas en la lordosis cervical del adulto entre sujetos normales, sujetos con dolor de cuello agudo y sujetos con dolor de cuello crónico.1,2

La figura 1 aquí abajo indica la lordosis cervical normal representativa.

Figura 1. ©Copyright Harrison CBP Seminars. Utilizada con permiso.

Revisión de la literatura que relaciona la lordosis a los desórdenes

Se han publicado múltiples investigaciones tratando de entender la asociación, correlación, o valor predictivo de una lordosis cervical alterada con diferentes condiciones de salud comparadas con controles normales. Con este fin, la mayoría de estos estudios han encontrado una correlación y una validez predictiva de la alineación radiográfica cervical lateral a una variedad de condiciones de salud relacionadas, entre ellas:

  1. Dolor de cuello agudo y crónico. 2-5
  2. Dolores de cabeza. 5-8
  3. Estado de salud mental. 9
  4. Desórdenes asociados con traumatismo cervical. 10-18
  5. Enfermedad degenerativa de las articulaciones. 19-30
  6. Desórdenes temporales de la articulación mandibular. 31
  7. Rango de movimiento y patrones de movimiento segmentarios. 32-34
  8. Síndromes respiratorios. 35-39
  9. Radiculopatía. 40,41
  10. Mayor probabilidad de lesión del tejido suave bajo impacto y cargas de inercia. 42-46

Por el contrario, pocas investigaciones han encontrado que las mediciones de alineación cervical lateral no se correlacionen ni predigan los hallazgos en las 10 categorías anteriores.47-52 Sin embargo, se ha encontrado que muchas de estas investigaciones han sido internamente fallidas y se han realizado revisiones detalladas de estos estudios.53-57 Por lo tanto, debería ser obvio que el número (45 estudios mencionados) y la calidad de las investigaciones que encuentran una correlación entre la alineación cervical lateral radiográfica y las condiciones en las 10 categorías anteriores es superior a los pocos estudios de correlación negativa. En los últimos 20 años, yo personalmente he concluido que la alineación cervical lateral radiográfica tiene una correlación positiva y validez predictiva para las 10 categorías anteriores de desórdenes de la columna y condiciones de salud.

RESUMEN

Las discusiones sobre la lordosis cervical tienen una larga historia en la literatura sobre la columna. Si bien nada está exento de controversia, la mayoría de los reportes de investigación pasada y presente indican que la lordosis cervical juega un papel principal en la salud humana, muchos desórdenes de la columna y varios desórdenes de salud. Mientras los programas de tratamiento en el consultorio que combinen procedimientos de tracción de extensión cervical, debería ser la regla de oro para ver mejoras consistentes y predecibles en pacientes que sufran de anomalías en la lordosis cervical, las ortesis de columna cervical correctivas realizadas en casa también deberían aplicarse.

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