Age-related Changes in Cervical Sagittal Alignment

Abstract

Study Design. Retrospective cohort study. Objective. To identify age-related changes in cervical sagittal parameters using standard radiographs. Summary of Background Data. Cervical sagittal balance is important for the maintenance of neutral head posture and horizontal gaze. Degenerative changes in the cervical spine that occur with aging may alter cervical sagittal balance, which can lead to chronic neck pain and predispose to various cervical spine pathologies. Methods. We performed a retrospective cohort study of 151 patients with lateral cervical spine radiographs taken at our institution between December 2017 and June 2018. Cervical sagittal parameters were measured, including C1 inclination, C2 slope, C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA), cervical tilt, upper and lower C7 slopes, T1 slope, and T1 slope minus cervical lordosis (TS-CL). The association between age and cervical sagittal parameters was assessed using the Pearson correlation coefficient and a linear regression analysis. An analysis of variance (ANOVA) with Tukey adjustments was then performed to identify differences in cervical sagittal parameters among patients aged 18 to 39 years, 40 to 64 years, and >64 years of age. Results. There were positive correlations between age and C2-C7 Cobb angle (r = 0.231, P = 0.004), upper C7 slope (r = 0.280, P < 0.001), lower C7 slope (r = 0.283, P < 0.001), and T1 slope (r = 0.189, P = 0.020). Upper C7 slope (R2 = 0.079) and lower C7 slope (R2 = 0.074) had the strongest correlation with age in the linear regression analysis. The ANOVA found significant differences among the age subgroups in terms of C2-C7 Cobb angle (P = 0.002), upper C7 slope (P < 0.001), lower C7 slope (P < 0.001), and T1 slope (P = 0.031). Patients >64 years old had significantly higher C2-C7 Cobb angle, upper C7 slope, lower C7 slope, and T1 slope. Conclusion. Changes in cervical sagittal alignment with age are characterized by increased cervical lordosis and increased thoracic kyphosis. Level of Evidence: 3

Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large‐scale morphological study

“…We found that cervical lordosis increased with age (Figure 2), as described in several previous radiographic studies (Guo et al, 2011; Inoue et al, 2020; Tang et al, 2019; Virk et al, 2020; Yeh et al, 2018; Yukawa et al, 2012, 2018; Zhou et al, 2020). However, the effect of age on cervical lordosis remains controversial.…”

Establishing a Method for Quantifying Spinal Curvature during Videofluoroscopic Swallow Studies: Applying the Modified Cobb Angle to Healthy Young and Older Adults

“…In addition, we found significant differences in curvature between younger and older healthy participants. More specifically, consistent with the existing spinal cord literature, cervical vertebrae two to four appear to increase in curvature with age [22][23][24][35][36][37][38].…”

“…Upon analyzing 21 studies, the authors found curvature was not significantly different between symptomatic and asymptomatic individuals, and age was not significantly associated with amount of lordotic cervical curvature. Interestingly, other studies have found that the angle of cervical lordosis tends to increase with age [34][35][36][37]. The parameter of interest for all of these studies was cervical lordosis -where the spine is curving posteriorly (see the image to the left of Figure 1).…”

Cervical Sagittal Alignment: Literature Review and Future Directions

“…Abelin-Genovois et al 78 ports, aged population showed increases cervical SVA, CL, and T1S which is mainly contributed from increased TK. 4,[87][88][89][90][91][92][93][94][95] Chen et al 96 (2017) and Liu et al 97 (2019) presented increasing TIA and NT with aging process as well as CL and T1S.…”