Abstract
PurposeTo clarify the relative influence of age, sex, disc height loss and T1 slope on upper (Occiput-C2) and lower cervical lordosis (C2–C7).MethodsStanding lateral cervical radiographs of 865 adult subjects were evaluated. The presence and severity of disc height loss from C2/C3 to C6/C7 (a total of 4325 discs) were assessed using a validated grading system. The total disc height loss score for each subject was calculated as the sum of the score of each disc space. Sagittal radiographic parameters included: occipital slope, occiput-C2 (Oc-C2) lordosis, C2–C7 lordosis and T1 slope. Multivariable regression analyses were performed to examine the relative influence of the multiple factors on upper and lower cervical lordosis.ResultsThis study included 360 males and 505 females, with a mean age of 40.2 ± 16.0 years (range, 20–95 years). Linear multivariate regression analyses showed that greater age, male sex, greater T1 slope were each found to be significantly and independently associated with greater C2–C7 lordosis, whereas total disc height loss score was negatively associated with C2–C7 lordosis. T1 slope had the most independent influence on C2–C7 lordosis among these factors. Age, sex and disc height loss were not independently associated with Oc-C2 lordosis.ConclusionsResults from our large-scale radiologic analysis may enhance the understanding of the factors that affect cervical lordosis, indicating that age, sex, disc height loss and T1 slope were each independently associated with C2–C7 lordosis. However, age, sex and disc height loss were not independently associated with upper cervical lordosis.
Highlights
Cervical lordosis is one of the critical parameters of cervical and global sagittal alignment [1, 2]
Sex, total disc height loss score, T1 slope and occipitocervical parameters were taken together, multivariate analysis showed that greater age, male sex, greater T1 slope and occipital slope were significantly associated with greater C2–C7 lordosis, whereas total disc height loss score and Oc-C2 angle were negatively associated with C2–C7 lordosis (Table 2)
We found that C2–C7 lordosis significantly increased with age
Summary
Cervical lordosis is one of the critical parameters of cervical and global sagittal alignment [1, 2]. The relative influence of age, sex, the extent of disc height loss and T1 slope on upper (occiput-C2) and lower cervical lordosis (C2–C7 angles) remains unknown. This knowledge gap exists since the majority of the previous investigations included a limited sample size, a narrowage range or did not analyse these common factors together within one study sample. We aim at clarifying the relative influence of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis by means of a retrospective analysis of the lateral radiographs of 865 adult subjects. The presence and severity of intervertebral disc space height loss from C2/C3 to C6/C7 (a total of 4325 intervertebral discs) in this study were scored according to
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