Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 1;44(19):E1144-E1150.
doi: 10.1097/BRS.0000000000003082.

Age-related Changes in Cervical Sagittal Alignment: A Radiographic Analysis

Ray Tang  1 , Ivan B Ye, Zoe B Cheung, Jun S Kim, Samuel Kang-Wook Cho
Affiliations

Age-related Changes in Cervical Sagittal Alignment: A Radiographic Analysis

Ray Tang et al. Spine (Phila Pa 1976). .

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 (R = 0.079) and lower C7 slope (R = 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.

PubMed Disclaimer

References

    1. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 2015; 76 (suppl 1):S14–21.
    1. Diebo BG, Challier V, Henry JK, et al. Predicting cervical alignment required to maintain horizontal gaze based on global spinal alignment. Spine (Phila Pa 1976) 2016; 41:1795–1800.
    1. Chen Y, Luo J, Pan Z, et al. The change of cervical spine alignment along with aging in asymptomatic population: a preliminary analysis. Eur Spine J 2017; 26:2363–2371.
    1. Park MS, Moon SH, Lee HM, et al. The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects. Spine (Phila Pa 1976) 2013; 38:E458–463.
    1. Nakamura N, Inaba Y, Aota Y, et al. New radiological parameters for the assessment of atlantoaxial instability in children with Down syndrome: the normal values and the risk of spinal cord injury. Bone Joint J 2016; 98-B:1704–1710.