title: Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration.
  
  
  BACKGROUND
  It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities.
  
  
  METHODS
  The authors performed a radiographic analysis of asymptomatic adults (referring to their cervical spine) of varying ages, with differing forms of spinal deformity to the thoracic/lumbar spine to see how cervical lordosis changes with increasing age. A total of 104 total spine EOS X-rays of adult (aged >18 years) spinal deformity patients without documented neck pain, prior neck surgery, or cervical deformity were reviewed. The researchers only reviewed EOS X-rays because they allow complete visualization from occiput to feet. Cervical lordosis, standard Cobb measurements, sagittal balance parameters, and cervical degeneration were quantified radiographically by the method previously described by Gore et al. Statistical analysis was performed with 1-way analysis of variance to compare significant differences between groups aged <40, 40-60 and >60 years as well as changes in sagittal balance. A p-value < .05 was considered significant.
  
  
  RESULTS
  Average CL actually increased with increasing age (10.3 ± 14.7, 15.4 ± 15.1, and 23.3 ± 1.6.7 for age < 40, 40-60, and > 60 years, respectively; p < .05). Average cervical degeneration score increased at all disc space levels from C2 to C7 across age groups (0.7 ± 1.2, 9.9 ± 69, and 16.3 ± 8.9 for age <40, 40-60, and >60 years, respectively; p < .01), with the highest degeneration at the C5-6 and C6-7 disc spaces (3.7 ± 3.3 and 3.2 ± 2.9, respectively; p < .01). This increase did not correlate with the increase in CL seen with aging (r = 0.02; p = .84).
  
  
  CONCLUSIONS
  Cervical lordosis increased with aging in adult spinal deformity patients. There was no relationship between cervical degeneration and lordosis despite the strong relationship seen between increasing CL in older age groups.
authors.affiliation: Hospital for Special Surgery, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110-1010, USA. Electronic address: lenkel@wudosis.wustl.edu.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Neurosurgery, Fort Suranaree Hospital, 555 Soi Ruamjit, Ractchasrima Road, Nakornchaisri Dusit Bangkok, 10300, Thailand.
authors.forename: Tapanut
authors.initials: T
authors.lastname: Chuntarapas
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave., Box 665, Rochester, NY 14642, USA.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
authors.affiliation: Florida Spine Specialists, 6000 North Federal Highway, Fort Lauderdale, FL 33308, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hershman
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Fogelson
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110-1010, USA.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
keywords: Cervical spine; Degeneration; Increasing age; Sagittal alignment