Cervical subcutaneous fat index and lordosis in intervertebral disc degeneration: is there a link?

This retrospective study investigated the relationship between cervical intervertebral disc degeneration (IVDD), cervical lordosis angle (CL), and posterior subcutaneous fat index (SFI) in adults with neck pain.

A total of 250 patients aged 18-65 years who underwent cervical magnetic resonance imaging (MRI) between 2023 and 2025 were included. Intervertebral discs from C2-T1 were graded using the Pfirrmann classification on T2-weighted midsagittal images. Cervical lordosis was measured using the posterior tangent method from C2-C7. Posterior SFI was calculated as the ratio of subcutaneous fat thickness to total posterior soft tissue thickness. Patients were grouped into loss of lordosis or normal lordosis groups. Statistical analyses included independent samples t-test, Spearman's correlation, and multiple regression analysis.

The mean age was 39.15 ± 12.79 years; 58% were female. Mean body mass index (BMI) was 22.45 ± 1.48 kg/m², and mean CL angle was -10.08 ± 11.33°. No significant differences were found in segmental SFI values between the loss of lordosis (N = 96) and normal lordosis (N = 154) groups (P > 0.05). Pfirrmann grades were comparable across most cervical levels, except at C6-7, where greater degeneration was observed in the normal lordosis group (P = 0.039). No significant correlations were identified between CL and either SFI or disc degeneration grades. Regression analysis showed that age, BMI, SFI, and Pfirrmann grade were not independent predictors of CL.

Posterior cervical SFI and CL were not generally associated with IVDD in this cohort. The isolated finding at C7-T1 should be interpreted cautiously. These results support the multifactorial nature of cervical disc degeneration and emphasise the need for larger prospective studies.