Cervical Lordosis: The Significance of Decreased, Straightened, and Reversed Curves
Charles N. Brooks
Search for other papers by Charles N. Brooks in
Current site
Google Scholar
PubMed
Close
,
Marjorie Eskay-Auerbach
Search for other papers by Marjorie Eskay-Auerbach in
Current site
Google Scholar
PubMed
Close
,
James B. Talmage
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Close
, and
Allan F. Tencer
Search for other papers by Allan F. Tencer in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

The normal cervical spine is straight in the coronal plane and usually is lordotic (curved convex anteriorly) in the sagittal plane, and although cervical spine deformity occurs in the coronal plane (eg, scoliosis), sagittal plane deformities are more common. For example, cervical lordosis can be increased (hyperlordosis) within the normal range, decreased (hypolordosis), absent (a straight cervical spine with 0° of curvature on a lateral X ray), or reversed (kyphosis). Primary deformity of the cervical spine often is congenital (eg, wedge vertebra); secondary sagittal deformities may be due to disc degeneration accompanying aging, disease such as ankylosing spondylitis, or surgery (eg, for postlaminectomy kyphosis). Decreased, straightened, or reversed cervical lordosis (DSRCL) may be idiopathic and can be voluntary, and evaluators must differentiate DSRCL that does not change over time vs sagittal plane alignment that varies over time or with a change in posture or position. DSRCL usually is asymptomatic, but severe cervical kyphosis can cause neck pain, myelopathy, dysphagia, loss of horizontal gaze, and other symptoms that are sufficiently severe to result in disability and to require surgical correction. Reports of DSRCL due to spasm, particularly at times temporally remote to an injury, should be met with extreme skepticism. Kyphosis of sufficient severity to be symptomatic usually is a postoperative deformity, not an effect of whiplash.

  • 1.

    Juhl JH, Muller SM, Roberts GW. Roentgenographic variations in the normal cervical spine. Radiology. 1962; 78: 591597.

  • 2.

    Fineman S, Borrellie FJ, Rubinstein BM, Epstein H, Jacobson HG. The cervical spine: transformation of the neutral lordotic pattern into a linear pattern in the neutral posture. JBJS Am. 1963; 45:11791184.

    • Search Google Scholar
    • Export Citation
  • 3.

    Beltsios M, Savvidou O, Mitsiokapa EA et al.. Sagittal alignment of the cervical spine after neck injury. Eur J Orthop Surg Traumatol. 2013; 23 (suppl 1): S47S51.

    • Search Google Scholar
    • Export Citation
  • 4.

    Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986; 11: 521524.

  • 5.

    Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine. 1997; 22:14721480.

    • Search Google Scholar
    • Export Citation
  • 6.

    McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005; 28: 187193.

    • Search Google Scholar
    • Export Citation
  • 7.

    Okada E, Matsumoto M, Ichihara D et al.. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow up of asymptomatic volunteers. Eur Spine J. 2009; 18:16441651.

    • Search Google Scholar
    • Export Citation
  • 8.

    Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine. 1994; 19: 16111618.

    • Search Google Scholar
    • Export Citation
  • 9.

    Beier G, Schuck M, Schuller E, Spann W. Determination of Physical Data of the Head I. Center of Gravity and Moments of Inertia of Human Heads Munich, Institute of Forensic Medicine, University of Munich, 1979; 44

    • Search Google Scholar
    • Export Citation
  • 10.

    Gay RE. The curve of the cervical spine: variations and significance.J Manipulative Physiol Ther. 1993; 16:591594.

  • 11.

    Louis R. Spinal stability as defined by the three-column spine concept. Anat Clin. 1985; 7: 3342.

  • 12.

    Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine. 1988; 13: 447449.

  • 13.

    Scheer JK, Tang JA, Smith JS et al.. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013; 19:141159.

    • Search Google Scholar
    • Export Citation
  • 14.

    Herman JM, Sonntag VKH. Cervical corpectomy and plate fixation for postlaminectomy kyphosis. J Neurosurg. 1994; 80:963970.

  • 15.

    Zdeblick TA, Bohlman HH. Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am. 1989; 71:170182.

    • Search Google Scholar
    • Export Citation
  • 16.

    Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine. 1998; 23:27382745.

  • 17.

    Davis AG. Injuries of the cervical spine. JAMA. 1945; 127; 149156.

  • 18.

    Helliwell PS, Evans PF, Wright V. The straight cervical spine: does it indicate muscle spasm? JBJS-Br. 1994; 76-B:103106.

  • 19.

    Schoenfeld BJ, Ogborn DI, Krieger JW. Effect of repetition duration during resistance training on muscle hypertrophy: a systematic review and meta-analysis. Sports Med. 2015; 45 (4): 577585.

    • Search Google Scholar
    • Export Citation
  • 20.

    Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J. 2007; 16:669678.

  • 21.

    Johansson MP, Baann Liane MS, Bendix T, Kasch H, Kongsted A. Does cervical kyphosis relate to symptoms following whiplash injury? Man Ther. 2011; 16:37838.

    • Search Google Scholar
    • Export Citation
  • 22.

    Jenkins LA, Capen DA, Zigler JE, Nelson RW, Nagelberg S. Cervical spine fusions for trauma. A long-term radiographic and clinical evaluation. Orthop Rev. 1994; (Suppl 1319).

    • Search Google Scholar
    • Export Citation
  • 23.

    Kawakami M, Tamaki T, Yoshida M, Hayashi N, Ando M, Yamada H. Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord. 1999; 12:5056.

    • Search Google Scholar
    • Export Citation
  • 24.

    Kwon B, Kim DH, Marvin A, Jenis LG. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech. 2005, 18:304308.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1905 1904 162
Full Text Views 28 28 0
PDF Downloads 0 0 0
Save