Relationship between cervical spinal alignment and degeneration

Objective:It is not known which parameters are important in the evaluation of cervical sagittal alignment. The aim of this study was to investigate the relationship between cervical spinal alignment and degeneration and to reveal possible causal link. Material-Method:Hospital radiologic database was screened for patients who had simultaneous cervical radiography and cervical magnetic resonance imaging (MRI) between 2014- 2019. Patients who had trauma/surgery, malignancy, infection, inflammatory disease, congenital anomaly or insufficient quality radiographies were excluded. Cervical lordosis angle (CLA), sagittal vertical axis (SVA), thoracic 1 slope (T1S), thoracic inlet angle (TIA), neck, cervical and cranial tilt measurements were performed. On sagittal MRI planes; degeneration was evaluated in six cervical segments and the amount of protrusions were measured.Patients were divided into two groups; those having Grade IV or V degeneration at any level in the Pfirmann classification were accepted to have severe degeneration (Group 2). Results:Out of 745 patients, 212 patients with a mean age of 45.05 ± 11.8 (18-65) years were included in the study. 52.8% of the patients were in Group 2. CL, T1S, neck tilt, cervical tilt, and cranial tilt angles were not different in both groups, while SVA and TGA were significantly higher in Group 2 (p <0.05 and p <0.01). The highest protrusion was in the C5-C6 level and in individuals over 40 years of age. TIA was correlated with age (r = 0.394) and for the predictive cut-off value was 68.2 ° for disc degeneration. Conclusion:SVA and TGA changes were more significantly related to the development of cervical degeneration than SL.