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Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients
Han Jo Kim1, Lawrence G Lenke2, Yasushi Oshima3
1Hospital for Special Surgery, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY 10021, USA.
Study Design:
Retrospective.
Objectives:
The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration.
Summary Of Background Data:
It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities.
Methods:
The authors performed a radiographic analysis of asymptomatic adults (referring to their cervical spine) of varying ages, with differing forms of spinal deformity to the thoracic/lumbar spine to see how cervical lordosis changes with increasing age. A total of 104 total spine EOS X-rays of adult (aged >18 years) spinal deformity patients without documented neck pain, prior neck surgery, or cervical deformity were reviewed. The researchers only reviewed EOS X-rays because they allow complete visualization from occiput to feet. Cervical lordosis, standard Cobb measurements, sagittal balance parameters, and cervical degeneration were quantified radiographically by the method previously described by Gore et al. Statistical analysis was performed with 1-way analysis of variance to compare significant differences between groups aged <40, 40-60 and >60 years as well as changes in sagittal balance. A p-value < .05 was considered significant.
Results:
Average CL actually increased with increasing age (10.3 ± 14.7, 15.4 ± 15.1, and 23.3 ± 1.6.7 for age < 40, 40-60, and > 60 years, respectively; p < .05). Average cervical degeneration score increased at all disc space levels from C2 to C7 across age groups (0.7 ± 1.2, 9.9 ± 69, and 16.3 ± 8.9 for age <40, 40-60, and >60 years, respectively; p < .01), with the highest degeneration at the C5-6 and C6-7 disc spaces (3.7 ± 3.3 and 3.2 ± 2.9, respectively; p < .01). This increase did not correlate with the increase in CL seen with aging (r = 0.02; p = .84).
Conclusions:
Cervical lordosis increased with aging in adult spinal deformity patients. There was no relationship between cervical degeneration and lordosis despite the strong relationship seen between increasing CL in older age groups.
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