Treatment of Mild Straightening of Cervical Lordosis
Mild straightening of the cervical lordosis is a common radiographic finding that does not necessarily indicate pathology or require specific treatment, as it occurs in 19-42% of normal individuals and is not reliably associated with muscle spasm or pain. 1, 2
Understanding the Clinical Significance
The loss of cervical lordosis should not be automatically attributed to muscle spasm or pathology. Research demonstrates that:
- Straightening of the cervical spine occurs in 42% of normal, asymptomatic individuals 1
- No significant difference exists in the prevalence of straight cervical spines between patients with acute neck injury (36%) and those without neck injury (36.5%) 2
- Women are 2.81 times more likely than men to have a straight cervical spine as a normal variant 1
- The hypothesis that loss of cervical lordosis reflects muscle spasm caused by neck pain is not supported by evidence 1, 2
Conservative Management Approach
For patients with neck pain and straightening of cervical lordosis, conservative management should be the initial approach, as 75-90% of patients with cervical radiculopathy achieve symptomatic relief with conservative therapy. 3
Initial Conservative Treatment (6+ weeks recommended):
- Activity modification and neck immobilization with a cervical collar for mild symptoms and axial neck pain 3
- Physical therapy and rehabilitative exercises focusing on cervical mobility 4
- Pain management with appropriate medications as needed 3
- Observation with follow-up is a reasonable option, as symptoms may resolve spontaneously in many cases 3
When to Consider Advanced Interventions
Specialized treatment should only be considered if:
- Conservative management fails after at least 6 weeks 5
- Neurological deficits develop (radiculopathy, myelopathy, or neurogenic claudication) 5, 3
- Radiographic evidence shows moderate to severe stenosis with neural compression 5
Chiropractic Manipulation (Optional):
- Spinal manipulation combined with cervical traction may improve cervical lordosis and reduce pain in select patients who have failed other conservative measures 6, 4
- One study showed improvement in cervical lordosis (mean 13-17.9 degrees) after 38 visits over 14.6 weeks with extension-compression traction and manipulation 6
- However, this should be reserved for patients without contraindications and after diagnostic screening for tolerance to cervical extension with compression 6
Critical Caveats
Do not assume straightening equals pathology. The alterations in normal cervical lordosis must be considered coincidental findings rather than indicators of muscle spasm or injury 2. Treatment should be directed at symptoms and functional impairment, not radiographic appearance alone.
Avoid unnecessary interventions. Since approximately 30-50% of patients with axial neck pain develop chronic symptoms lasting more than a year 3, focus on functional improvement and pain control rather than attempting to "correct" radiographic alignment that may represent normal variation.