Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters

Spine J. 2018 May;18(5):797-810. doi: 10.1016/j.spinee.2017.09.008. Epub 2017 Sep 27.


Background context: Many studies tend to characterize cervical kyphosis as a significant clinical condition that needs to be treated. Moreover, opinions vary on whether cervical kyphosis should be considered a pathologic status or a natural occurrence in asymptomatic people.

Purpose: This study aimed to determine the frequency of kyphotic posture of the cervical spine in currently asymptomatic individuals and to ascertain its relation with other spinopelvic parameters.

Study design: A cross-sectional radiographic study was carried out.

Patient sample: This study targeted 1,026 currently asymptomatic adult volunteers who agreed to participate in this study from January 2010 to March 2016. Only 958 were eligible for the study.

Outcome measures: Radiographic images, including the C-spine dynamic view and whole-spine lateral view, were measured. The sagittal parameters of the cervical spine and other parts of the spine and pelvis, such as the C2-C7 angle, C0-C2 range of motion (ROM), C2-C7 ROM, and C0-C7 ROM, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence, were measured.

Methods: Based on the C-spine neutral lateral X-ray, a C2-C7 Cobb angle greater than 0 degree was defined as lordosis and an angle less than 0 degree was defined as kyphosis. Patients who showed kyphosis were further classified into the reducible or non-reducible group, depending on the ability of recovering neck motions (lordosis) in extension. The cervical and other global spine parameters between the two groups were analyzed, and the relation between the cervical alignment and other parts of the spine and pelvis were also examined. This study was not supported by any funding and had no conflicts of interest.

Results: Nearly one-fourth of the asymptomatic participants (26.3%) have kyphotic cervical posture, and almost one-sixth of the kyphotic individuals (16.7%) have non-reducible kyphosis. The prevalence increases with advanced age; non-reducible cases are mostly kyphotic, kyphosis stems from the C2-C7 region, and kyphosis is not correlated with any of the radiological parameters of the other parts of the spine except lumbar lordosis.

Conclusions: Cervical kyphosis can be observed in normal healthy adults.

Keywords: Alignment; Cervical spine; Frequency; Kyphosis; Posture; Prevalence.

MeSH terms

  • Adult
  • Aged
  • Asymptomatic Diseases / epidemiology
  • Cervical Vertebrae / diagnostic imaging*
  • Female
  • Humans
  • Kyphosis / diagnostic imaging*
  • Kyphosis / epidemiology
  • Kyphosis / pathology
  • Male
  • Middle Aged
  • Posture
  • Radiography
  • Range of Motion, Articular