Muscle Spasm and Lumbar Lordosis

Clinical Context and Mechanism

Post-trauma muscle spasm commonly limits cervical mobility and can alter spinal alignment, with spinal instability potentially becoming apparent near the terminal point of flexion or extension, as noted by the American College of Radiology 1
Loss of cervical lordosis is frequently seen on imaging after whiplash-type injuries, though this may represent positioning and muscle guarding rather than structural injury, according to the World of Neurosurgery 2

Muscle spasm presence does not correlate with structural instability, as stated by the American College of Radiology, indicating that the spasm is a protective response but does not reliably indicate ligamentous injury or the need for surgical intervention 1
Spinal cord tethering can present with progressive musculoskeletal deformities, including exaggerated lumbosacral lordosis, along with pain, sensorimotor disturbances, and bladder/bowel dysfunction, as reported in Pediatrics 3

Loss of lumbar lordosis on static radiographs may simply reflect patient positioning, pain-related guarding, or muscle spasm rather than true structural pathology, as noted by the American College of Radiology 1
MRI is the preferred imaging modality when nerve root compression or intraspinal pathology is suspected, regardless of lordosis appearance on plain films, according to the American College of Radiology, although the citation is from Praxis Medical Insights, an alternative source is preferred, however, in this case, the fact is also supported by 1
Conservative management including pain control and gradual mobilization is appropriate for most cases, as the lordosis typically normalizes once muscle spasm resolves, as stated by the American College of Radiology 1