• Yann Philippe Charles, Solène Prost, Sébastien Pesenti, Brice Ilharreborde, Eloïse Bauduin, Féthi Laouissat, Guillaume Riouallon, Stéphane Wolff, Vincent Challier, Ibrahim Obeid, Louis Boissière, Emmanuelle Ferrero, Federico Solla, Jean-Charles Le Huec, Stéphane Bourret, Joe Faddoul, Georges Naïm Abi Lahoud, Vincent Fière, Michiel Vande Kerckhove, Matthieu Campana, Jonathan Lebhar, Hadrien Giorgi, Aymeric Faure, Erik André Sauleau, Benjamin Blondel, and French Spine Surgery Society (SFCR).
• Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France. YannPhilippe.CHARLES@chru-strasbourg.fr.
• Eur Spine J. 2022 May 1; 31 (5): 1228-1240.

PurposeThe aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment.MethodsA total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated.ResultsAmong cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95).ConclusionCervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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