Alterations of Cervical Lordosis in Neck Pain Patients

Chronic neck pain is a common musculoskeletal condition characterized by persistent pain in the neck lasting more than 3 months. The natural lordotic curvature of the cervical spine can impact the stability of the cervical vertebrae, and alterations to this curvature can lead to neck pain and disability. Our primary objective was to investigate the association of cervical lordosis with neck pain. Secondarily, we also examined the relationship of Cobb's angle and Jackson physiological stress (JPS) angle with age, gender and BMI.

This prospective cross-sectional study included 255 adult patients of either gender having neck pain. The patients were stratified into three groups. Neck pain cases without radiation to upper limb were categorised as group I, those with radiation to upper limb as group II and those with neck pain with radiculopathy/ myelopathy as group III. Lateral projection radiograph of cervical spine was obtained for all subjects. Cobb's angle (C2-C7) & Jackson physiological stress (JPS) angle were measured using DICOM software.

Neck pain cases in group I included 93 cases, group II had 98 cases and group III had 64 cases. The mean cervical lordosis as measured by Cobb's angle was 27.24 ± 9.17 degrees and by JPS angle was 30.65 ± 10.39 degrees (P<0.0001). Both, Cobb's and JPS angle were similar in all age groups, gender and BMI subcategories (Cobb's angle: p= 0.631, p=0.156, p=0.61; JPS angle: p=0.396, p=0.0804, p=0.539) respectively. The degree of lordosis was similar in all three pain sub-type when measured by Cobb's method (p=0.969) or by JPS angle (p=0.952).

The study found that cervical lordosis (Cobb's angle and Jackson physiological stress angle) has no association with cases having neck pain with or without radiation to upper limbs or neck pain with radiculopathy/ myelopathy. Cervical lordosis does not vary significantly with age, gender and BMI irrespective of the method used.