Cervical lordosis has important clinical and surgical implications. Cervical spine curvature is reported with considerable variability in individual studies. The aim of this study was to examine the existence and extent of cervical lordosis in asymptomatic individuals and to evaluate its relationship with age and gender. A comprehensive literature search was conducted in several electronic databases. Study selection was based on pre-determined eligibility criteria. Random effects meta-analyses were performed to estimate the proportion of asymptomatic individuals with lordosis and the effect size of cervical lordotic curvature in these individuals which followed metaregression analysis to examine the factors affecting cervical lordosis. Data from 21 studies (15,364 asymptomatic individuals, age 42.30 years [95% confidence interval 36.42, 48.18], 54.2% males) were used in the present study. In this population, 63.99% [95% confidence interval 44.94, 83.03] individuals possessed lordotic curvature. Degree of lordotic curvature differed by method of measurement; 12.71° [6.59, 18.84] with Cobb C2–C7 method and 18.55° [14.48, 22.63] with posterior tangent method. Lordotic curvature was not significantly different between symptomatic and asymptomatic individuals but was significantly higher in males in comparison with females. Age was not significantly associated with lordotic cervical curvature. Majority of the asymptomatic individuals possesses lordotic cervical curvature which is higher in males than in females but have no relationship with age or symptoms.

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Cervical lordosis in asymptomatic individuals: a meta-analysis

Disruption of the cervical lordotic curve can cause undesirable symptoms such as neck pain, and cord compression. The purpose of this study was to investigate the biomechanics of loss of cervical lordosis by measuring the cross-sectional area (CSA) of the cervical muscles using magnetic resonance imaging (MRI), and to determine the relationship between cervical lordosis angle and cervical muscle status. The cervical lordosis angle was measured on standing lateral plain radiography using the posterior tangent technique in patients who complained of neck pain. The CSAs of the cervical flexor muscles including the longus cervicis and longus capitis, the cervical extensor muscles including the splenius capitis and semispinalis capitis, and the sternocleidomastoid muscle, were measured at the maximum levels by axial T1-weighted MRI. We compared neck muscle CSAs between the two groups, the correlation with cervical lordosis angle, and muscle status including CSA and imbalance. The CSA of the semispinalis capitis was significantly lower in the loss of cervical lordosis group, and the ratio of cervical flexor to extensor was significantly different between the two groups (P < 0.05). Partial correlation analysis revealed that the cervical lordotic angle was significantly positively correlated with the ratio of flexor to extensor muscle CSAs (P < 0.05). There is a significant relationship between cervical muscle imbalance, including extensor muscle weakness, and loss of cervical lordosis. An exercise program focusing on cervical extensor muscle strengthening and restoring the balance of flexor and extensor muscles is recommended for patients with loss of cervical lordosis. Clin. Anat. 31:710-715, 2018. © 2018 Wiley Periodicals, Inc.

Association between cervical lordotic curvature and cervical muscle cross‐sectional area in patients with loss of cervical lordosis

Neck pain is a diffuse problem with a high incidence and often leads to the more or less appropriate prescription of imaging studies of the cervical spine. In general, this is represented by a magnetic resonance imaging (MRI) scan. Frequently such studies reveal no other significant findings apart from a loss of cervical lordosis either under the form of a simple straightening of the spine or even an inversion of the normal curvature into a kyphosis. Faced with this entity, the clinician is put in front of a series of questions: to which extent such a finding plays a role in the patient's symptoms? If it does what is the role of conservative or even invasive treatment? What are the implications for surgery either for decompressive procedures or corrective procedures? To shed some light on these questions, the authors present a narrative review of the most relevant literature on the topic. Papers examined span from the initial epidemiologic reports out of the pre-MRI and computerized tomography era up to the most recent discussions on cervical sagittal alignment and its implications both for the surgical and nonsurgical patient. In this process, it becomes increasingly clear that we are still far from making any definite statements.

Loss of cervical lordosis: What is the prognosis?

[Purpose] To systematically review the literature on the use of cervical extension traction methods for increasing cervical lordosis in those with hypolordosis and cervical spine disorders. [Methods] Literature searches for controlled clinical trials were performed in Pubmed, PEDro, Cochrane, and ICL databases. Search terms included iterations related to the cervical spine, neck pain and disorders, and extension traction rehabilitation. [Results] Of 1,001 initially located articles, 9 met the inclusion/exclusion criteria. The trials demonstrated increases in radiographically measured lordosis of 12-18°, over 5-15 weeks, after 15-60 treatment sessions. Untreated controls/comparison groups not receiving extension traction showed no increase in cervical lordosis. Several trials demonstrated that both traction and comparison treatment groups experienced immediate pain relief. Traction treatment groups maintained their pain and disability improvements up to 1.5 years later. Comparative groups not receiving lordosis improvement experienced regression of symptoms towards pre-treatment values by 1 years' follow-up. [Conclusion] There are several high-quality controlled clinical trials substantiating that increasing cervical lordosis by extension traction as part of a spinal rehabilitation program reduces pain and disability and improves functional measures, and that these improvements are maintained long-term. Comparative groups who receive multimodal rehabilitation but not extension traction experience temporary relief that regresses after treatment cessation.

Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: a systematic review of controlled trials.

[Purpose] To present a case of the non-surgical improvement in cervical kyphosis in a patient with history of cervical spine trauma and advanced osteoarthritis. [Subject and Methods] A 38 year old male presented with a chief complaint of chronic neck pain that was not substantially relieved by recent previous traditional physiotherapy and chiropractic manipulation. The cervical radiograph demonstrated a cervical hypolordosis of 5° as measured by the Harrison posterior tangent method from C2-C7. There was a 15° kyphosis at C4-C6 with advanced degenerative changes consistent with previous spine trauma. The patient was treated by CBP® methods incorporating cervical extension traction, extension exercises, and spinal manipulation for 30 sessions over an 18 week period. [Results] After the treatment sessions, there was a substantial (27°) increase in global C2-C7 lordosis, and 5° decrease in C4-C6 degenerative kyphosis corresponding to the reduction in neck pain and disability, and an improvement in overall health status as indicated on the SF-36 health questionnaire. [Conclusion] Although degenerative spondylosis of the cervical spine will have physical limitations to non-surgical correction, this case serves as an example that it is possible to reduce degenerative kyphosis and increase global cervical lordosis corresponding to health improvements in these patients.

Non-surgical improvement of cervical lordosis is possible in advanced spinal osteoarthritis: a CBP® case report.

The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using ‘Image J’ digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962–0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12). This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

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Michael Shilton

Papers

Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study