Co-relation between cervicothoracic angle and neck pain in adults

Introduction: Neck pain is the fourth most common cause of disability after lower back pain, depression, and joint pain. Cervical sagittal balance is as crucial as pelvic sagittal alignment and is related to the concept of T1 alignment. Materials and Methods: An observational cross sectional study was conducted on 235 Patients diagnosed as neck pain and treated at our institute between August 2017 to July 2019 with age between 20-80 years with neck pain complaints and on medication were included in this study. Pain and functional improvements were assessed using visual analogue scale (VAS) and neck disability index (NDI). Standing lateral view and standing swimmers lateral view of cervical spine radiographs were taken and studied for evaluating cervicothoracic parameters T1 slope and SVA (Saggital Vertical Axis) C2-7, following neck pain and compared with normal ranges. Variations of these criteria have been reported along with the scores of the questionnaire. Statistical analysis was carried out using the edition 21.0 of the Statistical Package for Social Sciences (SPSS). Results: After analysis, it was found that the average T1 slope was 27.82 + 14.33, the average male T1 slope was 26.74 + 14.21 and the average female T1 slope was 28.56 + 14.42. According to Sang et al average T1 slope is 25.7.5 + 6.4 which was taken as a reference for comparison with the asymptomatic population, our study had an increased value but was not signiﬁcant. Conclusions: The pain in the neck increases with age. It is more prevalent in females. Study shows an increase in neck pain with increasing age due to degenerative changes in the T1 slope, SVA C2-C7. There is no signiﬁcant correlation with cervical and neck pain or disability but a good relationship between the two. There was no substantial difference in cervical curve between symptomatic and asymptomatic patients.


Introduction
Neck pain is the fourth most common cause of disability after lower back pain, depression, and joint pain. 1 Simple conditions that are prone to accumulation such as mechanical stress, lack of muscle strength, office computer jobs, non-ergonomic working environments, and long working hours result in neck pain being more frequently seen in middle age. 2 Cervical vertebral X-ray is the most common diagnostic tool used in this circumstance. 3,4 Cervical sagittal balance Due to a lack of clear consensus on the relationship between cervico-thoracic parameters and neck pain in the literature, we aimed to determine the various cervical thoracic junction parameters of our patients with radiographs due to better affordability. The present study was plan with aimed to examine whether the sagittal profile of the cervicothoracic spine shows any association with the presence and severity of neck pain in the adult population. Patient's information, history, pre-tested pain scale, and pre-tested disability index were obtained. The patients were explained in detail about the condition and the study protocol and informed consent were taken for utilizing the radiograph and examination findings for the study. Radiographic Examination following clinical assessment by the attending specialist, all patients underwent standing lateral view and standing swimmers lateral view of cervical spine radiographs were taken and studied for evaluating various cervicothoracic parameters following neck pain and compared with normal ranges of the parameter studied. Pain and functional improvements were assessed using visual analogue scale (VAS) and neck disability index (NDI). 6 Measurement of Radiographic Parameters The radiographic film cassette was placed 72 inches from the tube, and radiographs were taken without magnification. Digital X-ray photographs were collected from the PACS method, which were used to collect orientation measurements.
Standing lateral view and standing swimmers lateral view of cervical spine radiographs were taken and studied for evaluating cervicothoracic parameters T1 slope and Saggital Vertical Axis (SVA) C2-7, following neck pain and compared with normal ranges of the parameter studied. Variations of these criteria have been reported along with the scores of the questionnaire. Statistical analysis was carried out using the edition 21.0 of the Statistical Package for Social Sciences (SPSS).

Observations and Results
In this research, 13.6 percent of patients in the age group between 20 and 40 years of age, 58.4 percent of patients in the age group between 41 and 60 years of age, and 28.1 percent in the age group between 61 and 80 years of age.  Of the study group (N=235), most of the patients belong to 41 to 60 year age group. In this research, 13.6 percent of patients in the age group between 20 and 40 years of age, 58.4 percent of patients in the age group between 41 and 60 years of age, and 28.1 percent in the age group between 61 and 80 years of age (

Discussion
Neck pain is a critical issue for public health. Approximately half of all people have a clinically significant episode of neck pain in their lifespan. Neck pain-related illness has both a patient and a community-based health and economic impact. The prevalence of neck pain is 10-15% all over the world.
In this study, the mean age of all patients was 51.5 ± 12.8 years. The mean age of male patients was 51.3 ± 12.67 years and the mean age of female patients was 51.88 ± 12.97 years. The difference was found to be nonimportant (P=0.7345). However, on a comparison between male and female groups, there was no difference found in the age group. In a study by Endo et al., 7 the mean age was found to 35.4±11.6 years while the mean age for males was 35.2±10.2 and females were 35.8±13.6 (p-value=0.86). In another study by Guo et al. 8 mean age was 42.30 years. A study done by Gore et al. 3 mean age was found to be 48.1 years. Yang et al. 9 found that most patients belong to the mean age of 46.3 ± 11.1 years (range 19-73) in males and 47.0 ± 11.8 years (range 20-69) in females. Nojiri et al. 10 observed in their study that, the mean age was 38.4 ± 17.4 years (male patients 37 ± 18 and female patients 39.7 ± 16.7 years of age).
The analysis found that the average T1 slope was 27.82 + 14.33, the average male T1 slope was 26.74 + 14.21 and the average female T1 slope was 28.56 + 14.42. According to Sang et al. 11 average T1 slope is 25.7.5 + 6.4 which was taken as a reference for comparison with the asymptomatic population, our study had an increased value but was not significant.
In the present study average SVA C2-C7 was 18.55 + 12.75, average male 17.34 + 11.99 and average female 19.36 + 13.25. Guo et al 8 also found out that asymptomatic population average SVA C2-C7 (mm) was 16.9 + 10.6. This study had no significant difference but slightly higher. Based on limited data that could be obtained under the eligibility criteria of this study, There was no significant difference found between symptomatic and asymptomatic individuals in the angle of lordosis of the cervical spine. However, this observation is identical to several other associated studies.

Conclusion
In this research, it was found that the pain in the neck increases with age. It is more prevalent in females. Study shows an increase in age due to degenerative changes in the T1 slope, SVA C2-C7. There is no significant correlation between cervical and neck pain or disability but a good relationship between the two. There is no substantial difference in cervical curve between symptomatic and asymptomatic patients.
There is therefore an immediate need for regular physical inspection, calcium and vitamin D supplements and regular exercise.

Source of Funding
Nil.

Conflicts of Interest
None declared.