The Association Between Cervical Spine Alignment and Neck Axial Pain in Early Twenties Soldiers

Abstract

Objective: Chronic neck pain is a common clinical problem, of which the annual prevalence is high. The relationship between the cervical axial pain and its sagittal alignment is controversial. The objective of this article was to study the relationship between cervical spine alignment measured by multiple methods and cervicalgia. Methods: We surveyed the patients who visited our hospital between May 2017 and December 2017 and shortlisted those aged between 19 and 25 years and had no cervical degenerative disease in their plain film and computer tomography. We retrospectively collected demographic characteristic and clinical manifestations. We measured the sagittal cervical alignment using Cobb's angle, Jackson physiologic stress line, Harrison's tangent, disc angle in each segments, cervical sagittal vertical axis, thoracic inlet angle, neck tilt angle and T1 slope in plain cervical lateral film. Results: Of 61 patients collected, 32 (52.4%) complained neck axial pain. We found that neck axial pain was significantly related to the kyphotic change of disc (p=0.004), the Jackson physiologic stress line (p=0.011), cervical sagittal vertical axis (p<0.001), neck tilting angle (p= 0.001) and thoracic inlet angle (p=0.041). Among measured values in plain film, T1 slope and cervical sagittal vertical axis were associated with clinical manifestation presented visual analysis scale (VAS) and Neck disability index (NDI) (p=0.035, p<0.001). In them, cervical vertical axis was significantly associated with clinical manifestation in multiple linear regression test (p<0.001). Conclusion: We recommended that the spinal surgeons should measure a cervical vertical axis for all patients suffered from cervicalgia.