C2–C7 sagittal alignment on lateral cervical X-rays and its correlation with neck pain,disability,and neurological symptoms

Abstract

Background

Cervical sagittal alignment is essential for proper load distribution and neural function. Alterations in the C2–C7 lordotic angle or sagittal vertical axis (SVA) may contribute to pain, functional decline, or neurological symptoms, but their relative clinical significance remains unclear.

Objective

To examine associations between C2–C7 lordotic angle, sagittal vertical axis (SVA), and clinical outcomes.

Methods

This retrospective cross-sectional study analyzed 130 outpatients undergoing lateral cervical radiography for neck pain. Patients were classified into normal lordosis (≥10 °) and hypolordosis (<10 °), and into three SVA groups (≤20 mm, 21–40 mm, >40 mm). Outcomes included Numeric Rating Scale (NRS), Neck Disability Index (NDI), and patient-reported neurological symptoms.

Results

Hypolordosis was significantly associated with higher Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores, but neurological symptoms did not differ by lordosis. Increasing sagittal vertical axis (SVA) correlated strongly with disability and neurological deficits. Patients with sagittal vertical axis (SVA) > 40 mm had elevated odds of arm numbness (OR ≈ 13.8) and weakness (OR = 9.0; multivariate OR ≈ 8.1) compared with sagittal vertical axis (SVA) ≤ 20 mm. Multivariate analyses identified lordotic angle as the strongest predictor of pain, whereas sagittal vertical axis (SVA) was the key determinant of disability and neurological symptoms.

Conclusion

The C2–C7 lordotic angle and sagittal vertical axis (SVA) play complementary roles: lordosis predicts neck pain, while sagittal vertical axis (SVA) reflects disability and neurological risk. Routine assessment of both, particularly sagittal vertical axis (SVA), may aid clinical decision-making in cervical spine disorders.

Keywords

cervical spine sagittal alignment C2–C7 lordosis sagittal vertical axis neck pain neurological symptoms

Get full access to this article

View all access options for this article.

References

Ames

Blondel

Scheer

, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 2013; 38: S149–S160.

Patwardhan

Khayatzadeh

Havey

, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J 2018; 27: 25–38.

Liu

Wang

, et al. Cervical sagittal parameters were closely related to neck disability Index score after anterior cervical decompression and fusion. J Orthop Surg Res 2020; 15: 94.

Barrey

Roussouly

Perrin

, et al. Sagittal balance disorders in severe degenerative spine. Eur Spine J 2011; 20: S626–S633.

Tang

Scheer

Smith

, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 2012; 71: 662–669.

Harrison

Janik

, et al. Comparison of axial and flexural stresses in lordosis and kyphosis of the cervical spine. J Manipulative Physiol Ther 2000; 23: 483–491.

McAviney

Schulz

Bock

, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005; 28: 187–193.

Moustafa

Diab

Harrison

. The efficacy of cervical lordosis rehabilitation for nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial with 2-year follow-up. J Clin Med 2022; 11: 6515.

Iyer

Nemani

Nguyen

, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976). 2016; 41: 371–377.

10.

Smith

Lafage

Ryan

, et al. Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America myelopathy study. Spine (Phila Pa 1976). 2013; 38: S161–S170.

11.

Nemani

VM.

Louie

PK.

Drolet

CE.

, et al.

Defining cervical sagittal plane deformity – when are sagittal realignment procedures necessary in patients presenting primarily with radiculopathy or myelopathy?

Neurospine 2022; 19: 876–882.

12.

Patel

Arutyunyan

Plusch

, et al. A review of cervical spine alignment in the normal and degenerative spine. J Spine Surg 2020; 6: 106–123.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.02 MB

0.00 MB