The association between cervical spine curvature and neck pain

Abstract

Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent. The aim of this study was to examine the correlation between the presence of neck pain and alterations of the normal cervical lordosis in people aged over 45 years. One hundred and seven volunteers, who were otherwise undergoing treatment for lower extremity problems in our hospital, took part. Sagittal radiographs of the cervical spine were taken and a questionnaire was completed, enquiring about neck pain and disability in the last 12 months. Based on the latter, subjects were divided into a group with neck pain (N = 54) and a group without neck pain (N = 53). The global curvature of the cervical spine (C2–C7) and each segmental angle were measured from the radiographs, using the posterior tangent method, and examined in relation to neck complaints. No significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity (P > 0.05). Twenty-three per cent of the people with neck pain and 17% of those without neck pain showed a segmental kyphosis deformity of more than 4° in at least one segment—most frequently at C4/5, closely followed by C5/6 and C3/4. The average segmental angle at the kyphotic level was 6.5° in the pain group and 6.3° in the group without pain, with a range of 5–10° in each group. In the group with neck pain, there was no association between any of the clinical characteristics (duration, frequency, intensity of pain; radiating pain; sensory/motor disturbances; disability; healthcare utilisation) and either global cervical curvature or segmental angles. The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain. This should be given due consideration in the differential diagnosis of patients with neck pain.

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References

  1. 1.

    Adams MA, Mannion AF, Dolan P (1999) Personal risk factors for first-time low back pain. Spine 24(23):2497–2505

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Albers D (1954) Eine Studie über die Funktion der Halswirbelsäule bei dorsaler und ventraler Flexion. Fortschr Geb Röntgenstr 81:606–615

    Google Scholar 

  3. 3.

    Altman DG (1980) Statistics of ethics in medical research. III How large a sample? Br Med J [Clin Res] 281:1336–1338

    Google Scholar 

  4. 4.

    Beaton DE (2000) Understanding the relevance of measured change through studies of responsiveness. Spine 25(24):3192–3199

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S (1990) Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(8):1178–1184

    PubMed  CAS  Google Scholar 

  6. 6.

    Borden AG, Rechtman AM, Gershon-Cohen J (1960) The normal cervical lordosis. Radiology 74:806–809

    PubMed  CAS  Google Scholar 

  7. 7.

    Bovim G, Schrader H, Sand T (1994) Neck pain in the general population. Spine 19(12):1307–1309

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Brattberg G, Thorslund M, Wikman A (1989) The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain 37(2):215–222

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Cote P, Cassidy JD, Carroll LJ, Kristman V (2004) The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 112(3):267–273

    PubMed  Article  Google Scholar 

  10. 10.

    Dawson EG, Kanim LE, Sra P, Dorey FJ, Goldstein TB, Delamarter RB, Sandhu HS (2002) Low back pain recollection versus concurrent accounts: outcomes analysis. Spine 27(9):984–993; discussion 994

    Google Scholar 

  11. 11.

    Elias F (1958) Roentgen findings in the asymptomatic cervical spine. NY State J Med 58(20):3300–3303

    CAS  Google Scholar 

  12. 12.

    Fineman S, Borrelli FJ, Rubinstein BM, Epstein H, Jacobson HG (1963) The cervical spine: transformation of the normal lordotic pattern into a linear pattern in the neutral posture. J Bone Joint Surg Am 45:1179–1183

    PubMed  CAS  Google Scholar 

  13. 13.

    Friedenberg ZB, Miller WT (1963) Degenerative disc disease of the cervical spine. J Bone Joint Surg Am 45:1171–1178

    PubMed  CAS  Google Scholar 

  14. 14.

    Frobin W, Brinckmann P, Leivseth G, Biggemann M, Reikeras O (1996) Precision measurement of segmental motion from flexion–extension radiographs of the lumbar spine. Clin Biomech (Bristol, Avon) 11(8):457–465

    Article  Google Scholar 

  15. 15.

    Gay RE (1993) The curve of the cervical spine: variations and significance. J Manipulative Physiol Ther 16(9):591–594

    PubMed  CAS  Google Scholar 

  16. 16.

    Gore DR (2001) Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine 26(22):2463–2466

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Gore DR, Sepic SB, Gardner GM (1986) Roentgenographic findings of the cervical spine in asymptomatic people. Spine 11(6):521–524

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Gore DR, Sepic SB, Gardner GM, Murray MP (1987) Neck pain: a long-term follow-up of 205 patients. Spine 12(1):1–5

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Hald HJ, Danz B, Schwab R, Burmeister K, Bähren W (1995) Radiographically demonstrable spinal changes in asymptomatic young men. Rofo 163(1):4–8

    PubMed  CAS  Google Scholar 

  20. 20.

    Hansson T, Bigos S, Beecher P, Wortley MD (1984) The lumbar lordosis in acute and chronic low-back pain. Spine 9(1):154–156

    Google Scholar 

  21. 21.

    Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22(13):1472–1480; discussion 1480

    Google Scholar 

  22. 22.

    Harrison DD, Troyanovich SJ, Harrison DE, Janik TJ, Murphy DJ (1996) A normal sagittal spinal configuration: a desirable clinical outcome. J Manipulative Physiol Ther 19(6):398–405

    PubMed  CAS  Google Scholar 

  23. 23.

    Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B (2000) Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 25(16):2072–2078

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Harrison DE, Harrison DD, Janik TJ, William Jones E, Cailliet R, Normand M (2001) Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clin Biomech (Bristol, Avon) 16(4):276–284

    Article  CAS  Google Scholar 

  25. 25.

    Harrison DE, Bula JM, Gore DR (2002) Roentgenographic findings in the cervical spine in asymptomatic persons: a 10-year follow-up. Spine 27(11):1249–1250

    PubMed  Article  Google Scholar 

  26. 26.

    Harrison DE, Jones EW, Janik TJ, Harrison DD (2002) Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model. J Manipulative Physiol Ther 25(6):391–401

    PubMed  Article  Google Scholar 

  27. 27.

    Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B (2004) Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 29(22):2485–2492

    PubMed  Article  Google Scholar 

  28. 28.

    Helliwell PS, Evans PF, Wright V (1994) The straight cervical spine: does it indicate muscle spasm? J Bone Joint Surg Br 76(1):103–106

    PubMed  CAS  Google Scholar 

  29. 29.

    Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30(1):1–15

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Juhl JH, Miller SM, Roberts GW (1962) Roentgenographic variations in the normal cervical spine. Radiology 78:591–597

    Google Scholar 

  31. 31.

    Katsuura A, Hukuda S, Saruhashi Y, Mori K (2001) Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10(4):320–324

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Kawakami M, Tamaki T, Yoshida M, Hayashi N, Ando M, Yamada H (1999) Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 12(1):50–56

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Kettner NW, Guebert GM (1991) The radiology of cervical spine injury. J Manipulative Physiol Ther 14(9):518–526

    PubMed  CAS  Google Scholar 

  34. 34.

    Kleinn F (1998) Zur Rolle strukturell fixierter Kyphosen und Skoliosen bei chronischen Rückenbeschwerden. Orthop Praxis 34(7):456–459

    Google Scholar 

  35. 35.

    Kristjansson E, Jonsson H Jr (2002) Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. J Manipulative Physiol Ther 25(9):550–555

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Liebig EM, Kothe R, Mannion AF, Grob D (2000) The clinical significance of the lumbar lordosis: relationship between lumbar spinal curvature and low back pain. Eur Spine J 9(4):286

    Google Scholar 

  37. 37.

    Marchiori DM, Henderson CN (1996) A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine 21(23):2747–2751

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    McKinnon ME, Vickers MR, Ruddock VM, Townsend J, Meade TW (1997) Community studies of the health service implications of low back pain. Spine 22(18):2161–2166

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Murrie VL, Dixon AK, Hollingworth W, Wilson H, Doyle TA (2003) Lumbar lordosis: study of patients with and without low back pain. Clin Anat 16(2):144–147

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Nojiri K, Matsumoto M, Chiba K, Maruiwa H, Nakamura M, Nishizawa T, Toyama Y (2003) Relationship between alignment of upper and lower cervical spine in asymptomatic individuals. J Neurosurg 99(1 Suppl):80–83

    PubMed  Google Scholar 

  41. 41.

    Owens EF, Hoiriis KT (1990) Cervical curvature assessment using digitized radiographic analysis. Chiropr Res J 4:47–62

    Google Scholar 

  42. 42.

    Panjabi M, Chang D, Dvorak J (1992) An analysis of errors in kinematic parameters associated with in vivo functional radiographs. Spine 17(2):200–205

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Perneger TV (1998) What’s wrong with Bonferroni adjustments. BMJ 316(7139):1236–1238

    PubMed  CAS  Google Scholar 

  44. 44.

    Plaugher G, Cremata EE, Phillips RB (1990) A retrospective consecutive case analysis of pretreatment and comparative static radiological parameters following chiropractic adjustments. J Manipulative Physiol Ther 13(9):498–506

    PubMed  CAS  Google Scholar 

  45. 45.

    Refshauge K (1994) Consistency of cervical and cervicothracic posture in standing. Aust J Physiother 40(4):235–240

    Google Scholar 

  46. 46.

    Takeshima T, Omokawa S, Takaoka T, Araki M, Ueda Y, Takakura Y (2002) Sagittal alignment of cervical flexion and extension: lateral radiographic analysis. Spine 27(15):E348–E355

    PubMed  Article  Google Scholar 

  47. 47.

    van Tulder MW, Assendelft WJ, Koes BW, Bouter LM (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine 22(4):427–434

    PubMed  Article  Google Scholar 

  48. 48.

    Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J (2003) Associations between back pain history and lumbar MRI findings. Spine 28(6):582–588

    PubMed  Article  Google Scholar 

  49. 49.

    Weh L, Rottker H (1990) Functional analysis of the cervical spine in healthy persons. Radiologe 30(2):87–91

    PubMed  CAS  Google Scholar 

  50. 50.

    Weir DC (1975) Roentgenographic signs of cervical injury. Clin Orthop Relat Res 109:9–17

    PubMed  Article  Google Scholar 

  51. 51.

    Wiegand R, Kettner NW, Brahee D, Marquina N (2003) Cervical spine geometry correlated to cervical degenerative disease in a symptomatic group. J Manipulative Physiol Ther 26(6):341–346

    PubMed  Article  Google Scholar 

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Correspondence to A. F. Mannion.

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Grob, D., Frauenfelder, H. & Mannion, A.F. The association between cervical spine curvature and neck pain. Eur Spine J 16, 669–678 (2007). https://doi.org/10.1007/s00586-006-0254-1

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Keywords

  • Cervical spine
  • Neck pain
  • Sagittal profile
  • Lordosis
  • Kyphotic deformity