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Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients

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Abstract

Study Design

Retrospective.

Objectives

The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration.

Summary of Background Data

It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities.

Methods

The authors performed a radiographic analysis of asymptomatic adults (referring to their cervical spine) of varying ages, with differing forms of spinal deformity to the thoracic/lumbar spine to see how cervical lordosis changes with increasing age. A total of 104 total spine EOS X-rays of adult (aged > 18 years) spinal deformity patients without documented neck pain, prior neck surgery, or cervical deformity were reviewed. The researchers only reviewed EOS X-rays because they allow complete visualization from occiput to feet. Cervical lordosis, standard Cobb measurements, sagittal balance parameters, and cervical degeneration were quantified radiographically by the method previously described by Gore et al. Statistical analysis was performed with 1-way analysis of variance to compare significant differences between groups aged <40, 40—60 and >60 years as well as changes in sagittal balance. A p-value <.05 was considered significant.

Results

Average CL actually increased with increasing age (10.3 ± 14.7, 15.4 ± 15.1, and 23.3 ± 1.6.7 for age < 40, 40—60, and > 60 years, respectively; p <.05). Average cervical degeneration score increased at all disc space levels from C2 to C7 across age groups (0.7 ± 1.2, 9.9 ± 69, and 16.3 ± 8.9 for age <40, 40—60, and >60 years, respectively; p <.01), with the highest degeneration at the C5—6 and C6—7 disc spaces (3.7 ± 3.3 and 3.2 ± 2.9, respectively; p <.01). This increase did not correlate with the increase in CL seen with aging (r = 0.02; p =.84).

Conclusions

Cervical lordosis increased with aging in adult spinal deformity patients. There was no relationship between cervical degeneration and lordosis despite the strong relationship seen between increasing CL in older age groups.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Han Jo Kim MD

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO, 63110-1010, USA

    Lawrence G. Lenke MD & K. Daniel Riew MD

  3. Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Yasushi Oshima MD

  4. Department of Neurosurgery, Fort Suranaree Hospital, 555 Soi Ruamjit, Ractchasrima Road, Nakornchaisri Dusit Bangkok, 10300, Thailand

    Tapanut Chuntarapas MD

  5. Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave., Box 665, Rochester, NY, 14642, USA

    Addisu Mesfin MD

  6. Florida Spine Specialists, 6000 North Federal Highway, Fort Lauderdale, FL, 33308, USA

    Stuart Hershman MD

  7. Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Jeremy L. Fogelson MD

Authors
  1. Han Jo Kim MD
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  2. Lawrence G. Lenke MD
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  3. Yasushi Oshima MD
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  4. Tapanut Chuntarapas MD
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  5. Addisu Mesfin MD
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  6. Stuart Hershman MD
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  7. Jeremy L. Fogelson MD
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  8. K. Daniel Riew MD
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Corresponding author

Correspondence to Lawrence G. Lenke MD.

Additional information

Author disclosures: HJK (consultant on the Spine Innovation Advisory Board of Medtronic, Inc); LGL (patents from Medtronic [unpaid]; royalties from Medtronic and Quality Medical Publishing; travel reimbursement monies related to meetings/course from BroadWater, Medtronic, SRS); YO (none); TC (none); AM (none); SH (none); JLF (none); KDR (expert testimony; grants from Medtronic for IDE participation; royalties from Osprey, Medtronic, Biomet; stock/stock options with Osprey, Expanding Orthopedics, Spineology, Spinal Kinetics, Amedica, Nexgen Spine, Vertiflex, Benvenue, Paradigm Spine, PSD).

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Kim, H.J., Lenke, L.G., Oshima, Y. et al. Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients. Spine Deform 2, 410–414 (2014). https://doi.org/10.1016/j.jspd.2014.05.007

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  • DOI: https://doi.org/10.1016/j.jspd.2014.05.007

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