What is the meaning of reversal of cervical lordosis?

Reversal of Cervical Lordosis: Meaning and Clinical Significance

Reversal of cervical lordosis refers to the loss of the normal forward curve (lordosis) in the neck, resulting in a straightened or backward-curved (kyphotic) cervical spine alignment. This radiographic finding is commonly observed on lateral cervical spine imaging and represents an alteration from the normal anatomical curvature.

Normal Cervical Anatomy vs. Reversal

• Normal cervical spine: Has a natural lordotic curve (concave posteriorly)
• Reversed lordosis: Shows straightening or kyphosis (convex posteriorly)

The normal cervical lordosis varies by age and gender:

• Males typically have smaller upper cervical lordosis (FM-C3) and higher lower cervical lordosis (C3-C7) than females 1
• Children and adults have similar total cervical lordosis, but the internal architecture differs 1

Clinical Significance

Relationship to Symptoms

Despite common assumptions, research shows limited correlation between cervical lordosis reversal and neck pain:

• A study examining the correlation between neck pain and cervical lordosis alterations found no significant difference in global curvature or segmental angles between patients with and without neck pain 2
• 23% of people with neck pain and 17% without pain showed segmental kyphosis deformity of more than 4 degrees in at least one segment 2

Potential Clinical Presentations

When symptomatic, reversal of cervical lordosis may be associated with:

1. Neck pain and stiffness
2. Headaches
3. Radiculopathy (nerve root compression symptoms)
4. Reduced range of motion

Causes of Cervical Lordosis Reversal

1. Muscle spasm/cervical contracture: Involuntary contractions of neck and shoulder muscles 3
2. Degenerative changes: Age-related wear and tear
3. Trauma: Previous neck injuries
4. Poor posture: Prolonged inadequate neck positions
5. Protective mechanism: Response to pain or injury

Diagnostic Approach

Imaging

• Plain radiographs: Initial evaluation to assess vertebral alignment and loss of normal cervical lordosis 3
• MRI: Indicated when neurological symptoms are present to evaluate disc pathology, spinal cord compression, or soft tissue abnormalities 3
• CT: Provides detailed bony anatomy assessment but is not typically first-line 3

Red Flags Requiring Immediate Imaging

• Focal neurologic deficit
• Midline spinal tenderness
• Progressive neurological deficits
• Signs of myelopathy
• Suspected infection or malignancy
• Severe or worsening pain unresponsive to conservative treatment 3

Management Approaches

Conservative Management (First-Line)

1. Physical therapy:

   • Strengthening exercises for neck and upper back
   • Postural correction exercises
   • Cervical extension and traction exercises
   • Gentle range of motion exercises 3

2. Non-pharmacologic approaches:

   • Heat therapy
   • Massage
   • Acupressure
   • Spinal manipulation 3

3. Pharmacologic options (for those who don't respond to non-pharmacologic approaches):

   • NSAIDs at lowest effective dose for shortest duration 3

Specialized Approaches

Some chiropractic approaches have reported success in restoring cervical lordosis:

• Chiropractic BioPhysics technique using extension-compression cervical traction combined with spinal manipulation has shown improvements in cervical lordosis and decreased chronic neck pain intensity 4
• Case reports demonstrate potential for reversal of cervical kyphosis into lordosis using specific cervical extension protocols 5, 6

Surgical Considerations

Surgical options should be considered only after 6-8 weeks of failed conservative management, or for progressive neurological deficit or development of myelopathic signs 3:

• Anterior Cervical Discectomy and Fusion (ACDF)
• Posterior decompression

Prognosis

The prognosis for reversal of cervical lordosis varies:

• Many cases remain asymptomatic and require no intervention
• When symptomatic, conservative management often provides relief
• Some cases may benefit from specific interventions to restore lordosis
• Surgical intervention is reserved for cases with neurological compromise or failed conservative management

Key Takeaways

1. Reversal of cervical lordosis is a radiographic finding that may or may not correlate with symptoms
2. The presence of structural abnormalities in patients with neck pain may be coincidental rather than causative 2
3. Conservative management focusing on physical therapy and postural correction is first-line treatment
4. Specialized techniques may help restore normal cervical lordosis in some cases
5. Surgical intervention is reserved for specific indications with neurological involvement