SIB #434- Decreased Lordosis- Impaired Vertebral Artery Flow

The Study: Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis

 Overview: This study was designed to test the hypothesis that reduced cervical lordosis may affect vertebral artery hemodynamics.

The Facts: 

a)      Loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. 

b)      A few studies have investigated the effect of cervical spondylosis on vertebral artery flow [6,7], to the best of our knowledge, no previous study has focused on the status of vertebral artery parameters specifically in patients with loss of cervical lordosis. 

c)      The study included thirty patients with loss of cervical lordosis and 30 controls with “normal cervical lordosis” who were matched for age, sex, and body mass index. 

d)     Measurements of the cervical curvature as measured from the posterior margins of  C2-C7 were obtained from lateral cervical radiographs. 

e)      Subjects were chosen from patients at an outpatient physical therapy clinic and were specifically excluded if they exhibited  any of the following;” hypoplastic vertebral artery, obesity (BMI ≥30), psychiatric disorders (e.g., depression and anxiety), alcohol or cigarette use, age younger than 18 or older than 45 years, cervical spondylosis, cervical rib, block vertebra, cardiovascular disorders (e.g., valvular heart disease), acute or chronic infections, rheumatic diseases, hypo- or hyperthyroidism, or any other systemic disorders.” 

f)       Vertebral arteries were evaluated bilaterally in all subjects using Doppler ultrasonography and the staff radiologist was blinded as to status of the subjects cervical lordosis. 

g)      Sonograms were performed on both right and left arteries with the patients in the supine position and the head turned to the contralateral side.  

h)      “The evaluation parameters included lumen diameter (LD), peak systolic velocity (PSV), and end-diastolic velocity (EDV) and were measured at the C5–6 intertransverse segment of the vertebral artery. 

 i)        All parameters were repeated three times and the mean values were used to compare differences between the groups. 

j)       The authors determined there was “significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity.”

Take Home: The results of the study revealed that vertebral artery hemodynamics including Lumen Diameter, Flow Volume and Peak Systolic Velocity were significantly lower in patients with loss of the normal neck curvature compared to those with normal lordosis.   

Reviewer's Comments: Prior studies have demonstrated a strong correlation between cervical spondylosis and decreased vertebral artery flow but this seems to be the first study to examine the effects of hypolordosis on the vertebral artery. In order to eliminate any confusion regarding the outcomes, this study was restricted to relatively young subjects (18-45 yrs) and specifically excluded anyone with cervical spondylosis visible on the radiographs thereby eliminating the potential for any overlap effect.  

Reviewer:  Mark R. Payne DC 

Reference:  Mehmet Deniz Bulut 1, Mahmut Alpayci 2, Emre Şenköy 2, Aydin Bora 1, Levent Yazmalar 3, Alpaslan Yavuz 1, İsmail Gülşen 4 Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis. Medical Science Monitor. 2016 Feb 15;22:495-500. doi: 10.12659/msm.897500. 

Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/26876295/

Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756865/