European Spine Journal

, Volume 18, Issue 11, pp 1644–1651 | Cite as

Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers

  • Eijiro Okada
  • Morio Matsumoto
  • Daisuke Ichihara
  • Kazuhiro Chiba
  • Yoshiaki Toyama
  • Hirokazu Fujiwara
  • Suketaka Momoshima
  • Yuji Nishiwaki
  • Takeshi Hashimoto
  • Jun Ogawa
  • Masahiko Watanabe
  • Takeshi Takahata
Original Article


There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 ± 14.5 years (11–65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal alignment of the cervical spine had some impact on the progression of degenerative changes of the cervical spine with aging; however, it had no correlation with the occurrence of future clinical symptoms.


Cervical spine Magnetic resonance imaging (MRI) Sagittal alignment Aging Asymptomatic volunteers 



This study was supported by a grant from the General Insurance Association of Japan. We express our cordial thanks to Dr. Tomoo Inoue of Yamanashi Hospital of Social Insurance, Dr. Yoshiji Suzuki of the Omaezaki Municipal Hospital, and Mr. Toshio Watanabe at the Central Radiotechnology Department of Keio University Hospital, for their cooperation for this study.

Conflict of interest statement

Morio Matsumoto has consultant fee from Medtronic Japan and Kyoei Fire & Marine Insurance and has received honorarium from the General Insurance Association of Japan for workshop. Kazuhiro Chiba has received honorarium from the General Insurance Association of Japan for workshop. The other authors have no conflict of interest.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Eijiro Okada
    • 1
  • Morio Matsumoto
    • 1
    • 8
  • Daisuke Ichihara
    • 1
  • Kazuhiro Chiba
    • 1
  • Yoshiaki Toyama
    • 1
  • Hirokazu Fujiwara
    • 2
  • Suketaka Momoshima
    • 2
  • Yuji Nishiwaki
    • 3
  • Takeshi Hashimoto
    • 4
  • Jun Ogawa
    • 5
  • Masahiko Watanabe
    • 6
  • Takeshi Takahata
    • 7
  1. 1.Department of Orthopaedic SurgeryKeio UniversityTokyoJapan
  2. 2.Department of Diagnostic RadiologyKeio UniversityTokyoJapan
  3. 3.Department of Preventive Medicine and Public HealthKeio UniversityTokyoJapan
  4. 4.Department of Orthopaedic Surgery, Tsukigase Rehabilitation CenterKeio UniversityShizuokaJapan
  5. 5.Department of Orthopaedic SurgeryKyorin UniversityTokyoJapan
  6. 6.Department of Orthopaedic SurgeryTokai UniversityKanagawaJapan
  7. 7.Department of Orthopaedic SurgeryIsehara Kyodo HospitalIseharaJapan
  8. 8.Department of Advanced Therapy for Spine and Spinal Cord DiseasesKeio UniversityTokyoJapan

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