Reversal of Cervical Lordosis: Definition and Clinical Meaning
Reversal of cervical lordosis means the normal forward curve of the neck has straightened or bent backward into a kyphotic (backward) curve, measured radiographically as a negative angle using methods like the Cobb technique. 1
Radiographic Definition
- A negative angle on lateral cervical radiographs indicates kyphosis or reversed lordosis, typically measured from C2-C7 using the Cobb method or posterior tangent method 1
- Normal cervical lordosis appears as a forward curve; reversal represents either straightening (0°) or frank kyphosis (negative angles) 1
- The measurement is taken between the inferior endplates of C2 and C7 vertebrae on standing or sitting lateral radiographs 2
Clinical Significance and Prognostic Implications
The development of kyphosis predicts poor outcomes in patients with cervical spine conditions (p < 0.05), particularly following surgical interventions. 1, 3
Evidence on Clinical Correlation
- In surgical patients, those who developed kyphosis (-12.5°) had different clinical trajectories compared to those who maintained lordosis (+1.1°), though the relationship is complex 1
- Post-laminoplasty kyphosis occurs in approximately 10% of patients and is associated with worse functional outcomes 4, 3
- However, in the general population without surgical intervention, the presence of reversed cervical lordosis does NOT correlate with neck pain or disability 5
Important Clinical Caveat
- In a study of 107 volunteers over age 45, there was no significant difference in global cervical curvature or segmental angles between those with neck pain (N=54) and those without (N=53) 5
- 23% of people with neck pain and 17% without neck pain showed segmental kyphosis deformity, most frequently at C4/5 5
- The presence of reversed lordosis in patients with neck pain must be considered coincidental and not necessarily the cause of symptoms 5
- Similarly, alterations in cervical lordosis after neck injury showed no significant difference compared to healthy controls and should not be automatically attributed to muscle spasm 2
Clinical Context for Interpretation
The clinical significance of reversed cervical lordosis depends entirely on the clinical context:
- In surgical patients (post-laminoplasty, post-fusion): Development of kyphosis is a negative prognostic indicator requiring close monitoring 4, 1, 3
- In degenerative myelopathy patients: Kyphosis development may predict poor outcomes and influence surgical planning 1, 3
- In general neck pain patients: The finding is likely incidental and should not drive treatment decisions in isolation 5