Management of Isolated Loss of Cervical Lordosis
For a patient with isolated loss of cervical lordosis, preserved vertebral body and disc heights, and no prevertebral soft tissue swelling, conservative management with physical therapy and cervical extension exercises is the recommended first-line treatment, with no indication for surgical intervention in the absence of neurological deficits or progressive symptoms. 1
Clinical Significance and Prognosis
- Isolated loss of cervical lordosis on imaging without associated fracture, disc herniation, or cord signal changes is not associated with clinically significant injury and does not require aggressive intervention 2
- In a prospective study of 1,007 trauma patients with isolated loss of lordosis on CT, no clinically significant injuries were found on MRI or flexion-extension views, and cervical collars were safely removed in all alert patients 2
- The relationship between loss of cervical lordosis and clinical symptoms remains complex, with degenerative changes being common in patients over 30 years and correlating poorly with symptoms in isolation 3
Conservative Treatment Protocol
Initial conservative management should be implemented for at least 3 months before considering any surgical evaluation: 1
- Cervical extension traction combined with physical therapy is the first-line approach 1
- Physical therapy focusing on exercises to strengthen neck muscles and improve posture 1
- Short-term muscle relaxants for associated muscle spasm 1
- Anti-inflammatory medications to reduce pain and inflammation 1
- Hot/cold therapy for temporary pain relief 1
- Activity modification to avoid positions that worsen symptoms 1
Evidence Supporting Conservative Care
- Case reports demonstrate that cervical extension traction and corrective exercises can restore cervical lordosis and provide complete symptom relief, with improvements maintained at long-term follow-up 4, 5, 6
- Restoration of cervical lordosis through conservative methods has been documented in as little as 10 weeks using cervical extension protocols 6
Surgical Indications (Not Applicable to This Case)
Surgery is reserved exclusively for patients with: 1
- Progressive neurological deficits 1
- Failure of conservative management after 3 months 1
- Evidence of spinal cord compression with myelopathic symptoms 3
Critical Clinical Pitfalls to Avoid
Do not apply cervical collars for isolated loss of lordosis - The 2015 International Consensus on First Aid Science recommends against routine cervical collar use, as potential harms (increased intracranial pressure, unnecessary neck movement during application) outweigh benefits 7
Do not pursue surgical intervention without clear indications - The 2025 World Neurosurgery systematic review suggests that early surgical intervention in patients without persistent canal compromise may be harmful, with case reports showing neurological deterioration following surgery for similar presentations 7
Do not over-interpret imaging findings - MRI findings of degenerative changes should be interpreted cautiously, as they are common and correlate poorly with symptoms in isolation 3
Monitoring and Follow-Up
- Reassess clinically after 3 months of conservative treatment 1
- Refer for surgical evaluation only if progressive neurological deficits develop or conservative treatment fails after 3 months 1
- Long periods of severe stenosis (not present in this case) can lead to potentially irreversible spinal cord damage, but this patient has preserved disc heights and no evidence of stenosis 1