Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Jia Li,Di Zhang,Yong Shen

doi:10.1186/s13018-020-01909-x

Abstract

BackgroundCervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.MethodsData pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analog scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.ResultsPatients who complained of ANP were categorized as ANP group (VAS score ≥ 3; n = 92), while those without ANP were categorized as non-ANP group (VAS score < 3; n = 171). There was no significant between-group difference with respect to age (P = 0.196), gender (P = 0.516), TIA (P = 0.139), NT (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695). The T1 slope and C2-7 SVA in the ANP group were significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P = 0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P = 0.028) were identified as risk factors for ANP.ConclusionsOur findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

Highlights

Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK)
C2-7 sagittal vertical axis (SVA) [odds ratio (OR) 2.318, 95% confidence interval (CI) 1.373–4.651, P = 0.003] and T1 slope were found to be independent predictors of axial neck pain (ANP) (Table 2)
There were no significant differences between the two groups with respect to age (P = 0.196), gender (P = 0.516), thoracic inlet angle (TIA) (P = 0.139), neck tilt (NT) (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695)

Summary

Introduction

Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). We evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK. Patients with cervical sagittal imbalance are more likely to develop axial neck pain (ANP). The relationship between cervical sagittal alignment (CSA) and axial neck pain (ANP) is not well characterized in contemporary literature. The Cobb angle method was typically used for assessment of CSA. This method does not allow for precise assessment of the segmental deformities [3,4,5,6]. Owing to the segmental deformities, results of Cobb angle method for assessment of cervical alignment may be misleading, especially in patients with cervical kyphosis (CK)

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