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.

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