European Spine Journal

, Volume 27, Issue 6, pp 1423–1431 | Cite as

Cut-off values of and factors associated with a negative influence on Neck Disability Index

  • Shin Oe
  • Daisuke Togawa
  • Go Yoshida
  • Tomohiko Hasegawa
  • Yu Yamato
  • Tatsuya Yasuda
  • Tomohiro Banno
  • Hideyuki Arima
  • Yuki Mihara
  • Hiroki Ushirozako
  • Yukihiro Matsuyama
Original Article



The Neck Disability Index (NDI) is used to evaluate patients with cervical spine disease. However, few reports have defined the cut-off values of the NDI. The purpose of this study was to identify the cut-off values of and factors with a negative impact on NDI.


A total of 487 volunteers were divided into three groups based on disability: none, mild, and disabled. The cut-off values of the NDI were determined using receiver-operating characteristic curves. After these groups were divided based on sex and age adjustment was performed, the factors with a negative impact on NDI were investigated using multiple logistic regression analysis.


Groups none, mild, and disabled included 207, 186, and 94 volunteers, respectively. The cut-off values of the NDI in each group were 0–5, 6–17, and ≥ 18%, respectively. After adjusting for age, groups none, mild, and disabled had 65, 56, and 23 males, respectively, and 92, 103, and 56 females, respectively. In multiple logistic regression analysis, the factors with a negative impact on NDI in males were manual work (odds ratio [OR] 1.924), higher T1 slope minus cervical lordosis (OR 1.043), and higher C2-7 sagittal vertical axis (OR 1.029, P < 0.05). Among females, the factors were hand-grip strength (OR 0.936), body fat percentage (OR 0.942), and sporting activity (OR 0.456, P < 0.05).


Deterioration in NDI was associated with cervical spinal malalignment and manual labor in males and lack of physical activity and sarcopenia in females.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Neck Disability Index Cut-off value Cervical spinal alignment Sarcopenia Manual worker 



Shin Oe and Daisuke Togawa belong to donated fund laboratory called Division of Geriatric Musculoskeletal Health. Source of funding as follows: Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., Meitoku Medical Institution Jyuzen Memorial Hospital. We have not received funding from the NIH, HHMI, or others.

Compliance with ethical standards

Conflict of interest

Shin Oe and Daisuke Togawa belong to donated fund laboratory called Division of Geriatric Musculoskeletal Health.

Ethical approval

The study protocol was approved by the institutional review board of Hamamatsu University School of Medicine, Shizuoka, Japan.

Supplementary material

586_2018_5555_MOESM1_ESM.pptx (157 kb)
Supplementary material 1 (PPTX 156 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Shin Oe
    • 1
  • Daisuke Togawa
    • 1
  • Go Yoshida
    • 2
  • Tomohiko Hasegawa
    • 2
  • Yu Yamato
    • 2
  • Tatsuya Yasuda
    • 3
  • Tomohiro Banno
    • 2
  • Hideyuki Arima
    • 2
  • Yuki Mihara
    • 2
  • Hiroki Ushirozako
    • 2
  • Yukihiro Matsuyama
    • 2
  1. 1.Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal HealthHamamatsu University School of MedicineHamamatsuJapan
  2. 2.Department of Orthopedic SurgeryHamamatsu University School of MedicineHamamatsuJapan
  3. 3.Department of Orthopedic SurgeryHamamatsu Medical CenterHamamatsuJapan

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