Analysis of Cervical Sagittal Alignment and Its Relationship With Spino-Pelvic Parameters in 410 Asymptomatic Children and Adolescents.

Study DesignRetrospective study.ObjectivesTo investigate the prevalence of cervical kyphosis, identify factors influencing cervical sagittal alignment and analyze its relationship with spino-pelvic parameters in asymptomatic children and adolescents.Methods410 asymptomatic children and adolescents aged 4-18 years were included. Cervical sagittal alignment types and radiographic parameters were measured in the full-length spine X-ray. Three groups were assigned according to Toyama method: lordotic group, straight and sigmoid group, kyphotic group. Participants were stratified by gender and age, and differences in spinal parameters were analyzed. To determine factors influencing cervical sagittal alignment, a multinomial logistic regression was conducted.ResultsAmong the 410 participants, 119 (29.0%) were classified as lordotic, 170 (41.5%) as straight, 5 (1.2%) as sigmoid, and 116 (28.3%) as kyphotic of the cervical sagittal alignment. Females exhibited a higher prevalence of kyphosis compared to males (35.8% vs 19.0%). Furthermore, kyphosis prevalence increased with age, from 0% in the 4-6-year-old group to 39.2% in the 16-18-year-old group. Strong positive correlations were observed between T1 slope and C2-C7 Cobb angle (r = 0.667, P < 0.01), as well as between lumbar lordosis and sacral slope (r = 0.758, P < 0.01). Age and C2-C7 Cobb angle were identified as predictors of cervical sagittal alignment via multinomial logistic regression analysis.ConclusionsThis study revealed that cervical kyphosis prevalence was comparable to lordosis in asymptomatic pediatric population, which challenged the traditional view of kyphosis as pathological. Additionally, cervical sagittal alignment showed significant gender- and age-related differences. These findings contribute to understanding pediatric cervical morphology and refining surgical strategies.