Age-related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic indivi
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ORIGINAL ARTICLE
Age‑related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic individuals Taro Inoue1 · Keigo Ito2 · Kei Ando1 · Kazuyoshi Kobayashi1 · Hiroaki Nakashima1 · Yoshito Katayama2 · Masaaki Machino1 · Shunsuke Kanbara1 · Sadayuki Ito1 · Hidetoshi Yamaguchi1 · Hiroyuki Koshimizu1 · Fumihiko Kato2 · Shiro Imagama1 Received: 14 April 2020 / Revised: 19 June 2020 / Accepted: 16 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To identify age-related changes and the relationship between upper and lower cervical sagittal alignment and the range of motion (ROM). Methods A total of 600 asymptomatic volunteers were enrolled. There were 50 males and 50 females in each decade of life between the third and the eighth. The O–C2 angle and the C2–7 angle were measured using the neutral radiographs of the cervical spine. ROM was assessed by measuring the difference in alignment in the neutral, flexion, and extension positions. Results The mean O–C2 angle in the neutral position was 14.0° lordotic. The mean ROM of the O–C2 angle was 23.1°. The mean C2–7 angle in the neutral position was 14.3° lordotic. The mean ROM of the C2–7 angle was 56.0°. The O–C2 angle was 16.1° in the third decade and gradually decreased to 11.4° in the eighth decade. There were no significant age-related changes in the ROM of the O–C2 angle. The C2–7 angle was 7.2° in the third decade and gradually increased to 20.8° in the eighth decade, and the ROM gradually decreased with increasing age. Significant negative correlation was observed between O–C2 angle and C2–7 angle. Conclusion The O–C2 angle gradually decreased and the C2–7 angle increased with age. The ROM of the O–C2 angle did not change, but the ROM of the C2–7 angle decreased with age. The upper and lower cervical spine showed different agerelated changes. Keywords Age-related changes · O–C2 angle · C2–7 angle · Range of motion · Cervical spine
Introduction With aging, changes in the cervical spine gradually increase and lead to cervical degenerative disease, such as cervical spondylosis and disk herniation. In the aging population, the proportion of patients with cervical degenerative disease can increase. Cervical corrective surgery aims to maintain normal cervical alignment. The radiological parameters of the sagittal balance of the thoracic and lumbar spine are well defined [1–3]. However, only few studies have assessed the * Shiro Imagama [email protected]‑u.ac.jp 1
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa‑ku, Nagoya, Aichi 466‑8560, Japan
Department of Orthopedic Surgery, Chubu Rosai Hospital, 1‑10‑6 Komei, Minato‑ku, Nagoya, Aichi 455‑8530, Japan
2
sagittal balance of the cervical spine; age-related changes in cervical sagittal alignment have rarely been evaluated. Some studies have shown the importance of local cervical sagittal alignment affecting the other parameters of global sagittal alignment [4, 5]. In add
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