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Sagittal alignment of the cervical spine after neck injury

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Abstract

The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

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References

  1. Hippocrates (1959) On joints, vol 1. Harvard University Press, Cambridge

    Google Scholar 

  2. Hippocrates (1927) Mochlicon (Instruments of reduction). In: Capps E, Page TE, Rouse WHD (eds) Withington ET, trans volume III. Hippocrates: The Loeb Classical Library. W. Heinemann, London, pp 398–449

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

    CAS  Google Scholar 

  4. Harrison DD, Janik TJ, Troyanovich SJ, Holland B (1996) Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine (Phila Pa 1976) 21(6):667–675

    Article  CAS  Google Scholar 

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

    CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  7. Gore DR, Sepic SB, Gardner GM (1986) Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976) 11(6):521–524

    Article  CAS  Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. 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 

  11. Bagnall KM, Harris PF, Jones PR (1977) A radiographic study of the human fetal spine. The development of the secondary cervical curvature. J Anat 124(3):791–802

    PubMed  CAS  Google Scholar 

  12. Cramer GD, Darby SA (2005) Basic and clinical anatomy of the spine, spinal cord and ANS, 2nd edn. Mosby, St. Louis

  13. Gelehrter VG (1963) Differential diagnose der halswirbelverletzungen im kindesalter. Fortshr Roentgen Str 99:506–517

    Article  CAS  Google Scholar 

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

    CAS  Google Scholar 

  15. Vischer CM, de Boer W, Naeije M (1998) The relationship between posture and curvature of the cervical spine. J Manip Phys Ther 21:267–280

    Google Scholar 

  16. Chen HB, Yang KH, Wang ZG (2009) Biomechanics of whiplash injury. Chin J Traumatol 12(5):305–314

    PubMed  Google Scholar 

  17. Kasai T, Ikata T, Katoh S, Miyake R, Tsubo M (1996) Growth of the cervical spine with special reference to its lordosis and mobility. Spine (Phila Pa 1976) 21(18):2067–2073

    Article  CAS  Google Scholar 

  18. Batzdorf U, Batzdorf A (1988) Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 22(5):827–836

    Article  PubMed  CAS  Google Scholar 

  19. Hellsing E, Reigo T, McWilliam J, Spangfort E (1987) Cervical and lumbar lordosis and thoracic kyphosis in 8, 11 and 15-year-old children. Eur J Orthod 9(2):129–138

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. 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 Jt Surg Am 45:1179–1183

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  23. 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 Manip Physiol Ther 25(9):550–555

    Article  CAS  Google Scholar 

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

    Google Scholar 

  25. Norris SH, Watt I (1983) The prognosis of neck injuries resulting from rear and vehicle collisions. J Bone Jt Surg Br 65:608–611

    CAS  Google Scholar 

  26. Hohl M (1974) Soft tissue injuries of the neck in automobile accidents. J Bone Jt Surg Am 56:1675–1682

    CAS  Google Scholar 

  27. Harris HJ, Mirvis SE (1996) Radiology of acute cervical spine trauma, 3rd edn. Lippincott William and Wilkins, Baltimore

    Google Scholar 

  28. Jackson R (1964) The positive findings in alleged neck injuries. Am J Orthop 6:178–187

    PubMed  CAS  Google Scholar 

  29. Braaf MN, Rosner S (1955) Symptomatology and treatment of injuries of the neck. NY State J Med 55:237–242

    CAS  Google Scholar 

  30. Davis AG (1945) Injuries of the cervical spine. JAMA 127(3):149–156

    Article  Google Scholar 

  31. DePalma AF, Subin DK (1965) Study of the cervical syndrome. Clin Orthop Relat Res 38:135–142

    PubMed  CAS  Google Scholar 

  32. Zatzkin HR, Kreton FW (1960) Evaluation of the cervical spine in whiplash injuries. Radiology 75:577–583

    PubMed  CAS  Google Scholar 

  33. Grauer JN, Panjabi MM, Cholewicki J, Nibu K, Dvorak J (1997) Whiplash produces an S-shaped curvature of the neck with hyperextension of lower levels. Spine (Phila Pa 1976) 22(21):2489–2494

    Article  CAS  Google Scholar 

  34. Maimaris C, Miles KA, Finley D, Barnes MR (1988) The incidence and prognostic significance of radiological abnormalities in soft tissue injuries to the cervical spine. Skeletal Radiol 17:493–496

    Article  PubMed  Google Scholar 

  35. Greenfield J, Ilfield FW (1977) Acute cervical strain evaluation and short-term prognostic factors. Clin Orthop Relat Res 122:196–200

    PubMed  Google Scholar 

  36. Hildingsson C, Toolanen G (1990) Outcome after soft-tissue injury of the cervical spine; a retrospective study of 93 car-accident victims. Acta Orthop Scand 61:357–359

    Article  PubMed  CAS  Google Scholar 

  37. Peterson CK, Wei T (1987) Vertical hyperplasia of the cervical articular pillars. Another look at the straight cervical spine. J Chiropractic 21:78–79

    Google Scholar 

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Correspondence to Michail Beltsios.

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Beltsios, M., Savvidou, O., Mitsiokapa, E.A. et al. Sagittal alignment of the cervical spine after neck injury. Eur J Orthop Surg Traumatol 23 (Suppl 1), 47–51 (2013). https://doi.org/10.1007/s00590-012-0966-3

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  • DOI: https://doi.org/10.1007/s00590-012-0966-3

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