Cervical Posture, Pain, and Pathology: Developmental, Evolutionary and Occupational Perspective

  • David Ezra
  • Ella Been
  • Deborah Alperovitch-Najenson
  • Leonid Kalichman


The cervical spine is the most mobile component of the spinal column. Its curvature (lordosis) supports the head above the shoulders, maintaining head position, gaze, and visual field. However, there is considerable variability in the cervical spine curvature of different individuals, generating several unresolved questions: What is a normal cervical curvature? How is cervical posture associated with cervical spine pain and pathology? How is erect posture and a modern lifestyle associated with cervical pain and pathology?

Based on the current literature, we found that many factors influence the extent of cervical lordosis and its internal architecture such as age, sex, and the morphology of adjacent anatomical regions—the thorax, the head, the lumbar spine, and the pelvis. We also found that cervical posture and alignment are correlated with cervical pathology and health-related quality of life. In the adult population, individuals with lordotic cervical spines (a Cobb angle (C0–C7) of ~40° ± 10 and Sagittal Vertical Axis (SVA) C2–C7 <40 mm) have less pathology and a better quality of life, while individuals with a straight/kyphotic/S-shape cervical spine (a small Cobb angle and SVA C2–C7 >40 mm) have greater cervical pathology, pain, and a lower quality of life.

It is clear today that certain workers in various professions suffer more from neck pain. Neck pain appears generally in those who sit for long periods of time, i.e., mostly office workers. Forward head posture and sustained sitting are typical risk factors for neck pain. The prolonged static trunk and neck postures together with excessive work of the stabilizing muscles, can cause neck pain. Cervical spine pathology has been observed in apes, extinct hominins, and prehistoric societies. Yet the evolution of cervical posture in hominins and its interaction, or lack of it, with neck pain and dysfunction is far from being resolved. Future studies should explore the prevalence and nature of cervical pathology in extinct and extant hominoids and in pre- and post-agricultural societies. Further investigations should also explore the interaction between cervical posture, pathology, and lifestyle in modern humans, and the efficacy of treatment methods for alleviating neck pain and pathology by improving posture.


Cervical lordosis Sagittal Vertical Axis (SVA) C2–C7 Ergonomics Forward head posture 


  1. Abelin-Genevois K, Idjerouidene A, Roussouly P, Vital JM, Garin C (2014) Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients. Eur Spine J 23(7):1442–1448PubMedCrossRefGoogle Scholar
  2. Albert TJ, Vacarro A (1998) Postlaminectomy kyphosis. Spine 23(24):2738–2745PubMedCrossRefGoogle Scholar
  3. Alperovitch-Najenson D, Katz-Leurer M, Santo Y, Golman D, Kalichman L (2010) Upper body quadrant pain in bus drivers. Arch Environ Occup Health 65(4):218–223PubMedCrossRefGoogle Scholar
  4. Ames CP, Smith JS, Scheer JK, Bess S, Bederman SS, Deviren V, Lafage V, Schwab F, Shaffrey CI (2012) Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 16(6):547–564PubMedCrossRefGoogle Scholar
  5. Ariëns GA, Bongers PM, Hoogendoorn WE, Houtman IL, van der Wal G, van Mechelen W (2001) High quantitative job demands and low coworker support as risk factors for neck pain: results of a prospective cohort study. Spine 26(17):1896–1901PubMedCrossRefGoogle Scholar
  6. Arlegi M, Gómez-Olivencia A, Albessard L, Martínez I, Balzeau A, Arsuaga JL, Been E (2017) The role of allometry and posture in the evolution of the hominin subaxial cervical spine. J Hum Evol 104:80–99PubMedPubMedCentralCrossRefGoogle Scholar
  7. Arsuaga JL, Martínez I, Arnold LJ, Aranburu A, Gracia-Téllez A, Sharp WD, Quam RM, Falguères C, Pantoja-Pérez A, Bischoff J, Poza-Rey E, Parés JM, Carretero JM, Demuro M, Lorenzo C, Sala N, Martinón-Torres M, García N, Alcázar De Velasco A, Cuenca-Bescós G, Gómez-Olivencia A, Moreno D, Pablos A, Shen C-C, Rodríguez L, Ortega AI, García R, Bonmatí A, Bermúdez De Castro JM, Carbonell E (2014) Neandertal roots: cranial and chronological evidence from Sima de los Huesos. Science 344:1358–1363CrossRefGoogle Scholar
  8. Bagnall KM, Harris PF, Jones PR (1977) A radiographic study of the human fetal spine. 2. The sequence of development of ossification centres in the vertebral column. J Anat 124(Pt 3):791PubMedPubMedCentralGoogle Scholar
  9. Bayerl S, Wiendieck K, Koeppen D, Topalovic M, Übelacker A, Kroppenstedt S, Cabraja M (2013) Single-and multi-level anterior decompression and fusion for cervical spondylotic myelopathy - A long-term follow-up with a minimum of 5 years. Clin Neurol Neurosurg 115(10):1966–1971PubMedCrossRefGoogle Scholar
  10. Been E, Gómez-Olivencia A, Shefi S, Soudack M, Bastir M, Barash A (2017a) Evolution of spinopelvic alignment in hominins. Anat Rec 300(5):900–911CrossRefGoogle Scholar
  11. Been E, Shefi S, Soudack M (2017b) Cervical lordosis: the effect of age and gender. Spine J 17(6):880–888CrossRefGoogle Scholar
  12. Been E, Shefi S, Zilka LR, Soudack M (2014) Foramen magnum orientation and its association with cervical lordosis: a model for reconstructing cervical curvature in archeological and extinct hominin specimens. Adv Anthropol 4(03):133CrossRefGoogle Scholar
  13. Beltsios M, Savvidou O, Mitsiokapa EA, Mavrogenis AF, Kaspiris A, Efstathopoulos N, Papagelopoulos PJ (2013) Sagittal alignment of the cervical spine after neck injury. Eur J Orthop Surg Traumatol 23(1):47–51CrossRefGoogle Scholar
  14. Borden AB, Rechtman AM, Gershon-Cohen J (1960) The normal cervical lordosis. Radiology 74(5):806–809PubMedCrossRefGoogle Scholar
  15. Bovenzi M (2015) A prospective cohort study of neck and shoulder pain in professional drivers. Ergonomics 58(7):1103–1116PubMedCrossRefPubMedCentralGoogle Scholar
  16. Boyle JJ, Milne N, Singer KP (2002) Influence of age on cervicothoracic spinal curvature: an ex vivo radiographic survey. Clin Biomech 17(5):361–367CrossRefGoogle Scholar
  17. Braaf MM, Rosner S (1975) Trauma of cervical spine as cause of chronic headache. J Trauma Acute Care Surg 15(5):441–446CrossRefGoogle Scholar
  18. Chen H, Zhong J, Tan J, Wu D, Jiang D (2013) Sagittal geometry of the middle and lower cervical endplates. Eur Spine J 22(7):1570–1575PubMedPubMedCentralCrossRefGoogle Scholar
  19. Claes F, Berger J, Stassijns G (2015) Arm and neck pain in ultra-sonographers. Hum Factors 57(2):238–245PubMedCrossRefGoogle Scholar
  20. Clement CD (1985) Gray’s anatomy, 13th edn. Lea & Febiger, Philadelphia, p 128Google Scholar
  21. Cobb JR (1948) Outline for the study of scoliosis. Instructional Course Lectures AAOS 5:261–275Google Scholar
  22. Cuccia AM, Lotti M, Caradonna D (2008) Oral breathing and head posture. Angle Orthod 78(1):77–82PubMedCrossRefGoogle Scholar
  23. Darivemula SB, Goswami K, Gupta SK, Salve H, Singh U, Goswami AK (2016) Work-related neck pain among desk job workers of tertiary care hospital in New Delhi, India: burden and determinants. Indian journal of community medicine: official publication of Indian Association of Preventive & social. Medicine 41(1):50Google Scholar
  24. Ezra D, Masharawi Y, Salame K, Slon V, Alperovitch-Najenson D, Hershkovitz I (2017) Demographic aspects in cervical vertebral bodies’ size and shape (C3–C7): a skeletal study. Spine J 17(1):135–142PubMedCrossRefGoogle Scholar
  25. Festa F, Tecco S, Dolci M, Ciufolo F, Meo SD, Filippi MR, Ferritto AL, D’Attillio M (2003) Relationship between cervical lordosis and facial morphology in Caucasian women with a skeletal class II malocclusion: a cross-sectional study. Cranio 21(2):121–129PubMedCrossRefGoogle Scholar
  26. Filler AG (2007) Emergence and optimization of upright posture among hominiform hominoids and the evolutionary pathophysiology of back pain. Neurosurg Focus 23(1):E4Google Scholar
  27. Friedman MJ (2006) The evolution of hominid bipedalism. Honors Projects. 16.
  28. Gay RE (1993) The curve of the cervical spine: variations and significance. J Manip Physiol Ther 16(9):591–594Google Scholar
  29. Gerszten PC, Gerszten E, Allison MJ (2001) Diseases of the spine in south American mummies. Neurosurgery 48(1):208–213PubMedGoogle Scholar
  30. Gok B, Sciubba DM, McLoughlin GS, McGirt M, Ayhan S, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF (2008) Surgical treatment of cervical spondylotic myelopathy with anterior compression: a review of 67 cases. J Neurosurg Spine 9(2):152–157PubMedCrossRefGoogle Scholar
  31. Gómez-Olivencia A (2013a) The presacral spine of the La Ferrassie 1 Neandertal: a revised inventory. Bulletins et Mémoires de la Societé d’Anthropologie de Paris 25:19–38CrossRefGoogle Scholar
  32. Gómez-Olivencia A (2013b) Back to the old man’s back: reassessment of the anatomical determination of the vertebrae of the Neandertal individual of La Chapelle-aux-saints. Annales de Paléontologie 99:43–65CrossRefGoogle Scholar
  33. Gómez-Olivencia A, Been E, Arsuaga JL, Stock JT (2013) The Neandertal vertebral column 1: the cervical spine. J Hum Evol 64(6):608–630CrossRefGoogle Scholar
  34. Gómez-Olivencia A, Carretero JM, Arsuaga JL, Rodríguez-García L, García-González R, Martínez I (2007) Metric and morphological study of the upper cervical spine from the Sima de Los Huesos site (sierra de Atapuerca, Burgos, Spain). J Hum Evol 53(1):6–25PubMedPubMedCentralCrossRefGoogle Scholar
  35. Gómez-Olivencia A, Quam R, Sala N, Bardey M, Ohman JC, Balzeau A (2018) La Ferrassie 1: new perspectives on a “classic” Neandertal. J Hum Evol 117:13–32PubMedCrossRefPubMedCentralGoogle Scholar
  36. Gore DR, Sepic SB, Gardner GM (1986) Roentgenographic findings of the cervical spine in asymptomatic people. Spine 11(6):521–524PubMedCrossRefGoogle Scholar
  37. Grave B, Brown T, Townsend G (1999) Comparison of cervicovertebral dimensions in Australian aborigines and Caucasians. Eur J Orthod 21(2):127–135PubMedCrossRefGoogle Scholar
  38. Grob D, Frauenfelder H, Mannion AF (2007) The association between cervical spine curvature and neck pain. Eur Spine J 16(5):669–678PubMedCrossRefGoogle Scholar
  39. Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP (2013) Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine 18(6):537–544PubMedCrossRefGoogle Scholar
  40. Haeusler M (2019) Spinal pathologies in fossil hominins. In: Been E, Gómez-Olivencia A, Kramer PA (eds) Spinal evolution: morphology, function, and pathology of the spine in hominoid evolution. Springer, New York, pp 213–246Google Scholar
  41. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW (1997) Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 22(13):1472–1479PubMedCrossRefGoogle Scholar
  42. Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B (2000) Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 25(16):2072–2078PubMedCrossRefGoogle Scholar
  43. Harrison DD, Janik TJ, Troyanovich SJ, Holland B (1996) Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 21(6):667–675PubMedCrossRefGoogle Scholar
  44. Hayes MJ, Osmotherly PG, Taylor JA, Smith DR, Ho A (2016) The effect of loupes on neck pain and disability among dental hygienists. Work 53(4):755–762PubMedCrossRefGoogle Scholar
  45. Helliwell PS, Evans PF, Wright V (1994) The straight cervical spine: does it indicate muscle spasm? J Bone Joint Surg 76(1):103–106CrossRefGoogle Scholar
  46. Huggare J, Houghton P (1996) Associations between atlantoaxial and craniomandibular anatomy. Growth Dev Aging 60(1):21–30PubMedGoogle Scholar
  47. Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19(14):1611–1618PubMedCrossRefGoogle Scholar
  48. Juhl JH, Miller SM, Roberts GW (1962) Roentgenographic variations in the normal cervical spine. Radiology 78(4):591–597CrossRefGoogle Scholar
  49. Jun HS, Chang IB, Song JH, Kim TH, Park MS, Kim SW, Oh JK (2014) Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine 39(10):E630–E636PubMedCrossRefGoogle Scholar
  50. Jun D, Zoe M, Johnston V, O’Leary S (2017) Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis. Int Arch Occup Environ Health 90(5):373–410PubMedCrossRefGoogle Scholar
  51. Jurmain RD (2000) Degenerative joint disease in African great apes: an evolutionary perspective. J Hum Evol 39:185–203PubMedCrossRefGoogle Scholar
  52. Kasai T, Ikata T, Katoh S, Miyake R, Tsubo M (1996) Growth of the cervical spine with special reference to its lordosis and mobility. Spine 21(18):2067–2073PubMedCrossRefGoogle Scholar
  53. Köhler K, Pálfi G, Molnár E, Zalai-Gaál I, Osztás A, Bánffy E, Kirinó K, Kiss KK, Mende BG (2014) A late Neolithic case of Pott’s disease from Hungary. Int J Osteoarchaeol 24(6):697–703CrossRefGoogle Scholar
  54. Le Huec JC, Demezon H, Aunoble S (2015) Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J 24(1):63–71PubMedCrossRefGoogle Scholar
  55. Lee SH, Kim KT, Seo EM, Suk KS, Kwack YH, Son ES (2012) The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech 25(2):E41–E47PubMedCrossRefGoogle Scholar
  56. Ling FP, Chevillotte T, Thompson W, Bouthors C, Le Huec JC (2018) Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur Spine J 27:1–8Google Scholar
  57. Lovell NC (1990) Skeletal and dental pathology of free-ranging mountain gorillas. Am J Phys Anthropol 81(3):399–412PubMedCrossRefGoogle Scholar
  58. Lovell NC (1994) Spinal arthritis and physical stress at bronze age Harappa. Am J Phys Anthropol 93(2):149–164PubMedCrossRefGoogle Scholar
  59. Lowenstine LJ, McManamon R, Terio KA (2016) Comparative pathology of aging great apes: bonobos, chimpanzees, gorillas, and orangutans. Vet Pathol 53(2):250–276PubMedCrossRefGoogle Scholar
  60. Machino M, Yukawa Y, Imagama S, Ito K, Katayama Y, Matsumoto T, Inoue T, Ouchida J, Tomita K, Ishiguro N, Kato F (2016) Age-related and degenerative changes in the osseous anatomy, alignment, and range of motion of the cervical spine: a comparative study of radiographic data from 1016 patients with cervical spondylotic myelopathy and 1230 asymptomatic subjects. Spine 41(6):476–482PubMedCrossRefGoogle Scholar
  61. Marchiori DM, Henderson CN (1996) A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine 21(23):2747–2751PubMedCrossRefGoogle Scholar
  62. Markuske H (1979) Relationships between the height of intervertebral discs and the degree of lordosis of the cervical spine in children. A roentgenometric study. Anat Anz 145(3):286–292PubMedGoogle Scholar
  63. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD (2008) Expenditures and health status among adults with back and neck problems. JAMA 299(6):656–664PubMedCrossRefGoogle Scholar
  64. Meyer MR (2016) The cervical vertebrae of KSD-VP-1/1. In: Haile-Selassie Y, Su D (eds) The postcranial anatomy of Australopithecus afarensis: new insights from KSD-VP-1/1. Springer, New York, pp 63–111CrossRefGoogle Scholar
  65. Mohanty C, Massicotte EM, Fehlings MG, Shamji MF (2015) Association of preoperative cervical spine alignment with spinal cord magnetic resonance imaging hyperintensity and myelopathy severity: analysis of a series of 124 cases. Spine 40(1):1–16CrossRefGoogle Scholar
  66. Moore KL, Dalley AF, Agur AM (2013) Clinically oriented anatomy. Lippincott Williams & Wilkins, Baltimore, MDGoogle Scholar
  67. Nagasawa A, Sakakibara T, Takahashi A (1993) Roentgenographic findings of the cervical spine in tension-type headache. Headache 33(2):90–95PubMedCrossRefGoogle Scholar
  68. Nalley TK, Grider-Potter N (2015) Functional morphology of the primate head and neck. Am J Phys Anthropol 156(4):531–542CrossRefGoogle Scholar
  69. Nejati P, Lotfian S, Moezy A, Nejati M (2015) The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health 28(2):295PubMedGoogle Scholar
  70. Núñez-Pereira S, Hitzl W, Bullmann V, Meier O, Koller H (2015) Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine 23(1):16–23PubMedCrossRefGoogle Scholar
  71. O’Rahilly R, Muller F, Meyer DB (1980) The human vertebral column at the end of the embryonic period proper. 1. The column as a whole. J Anat 131(Pt 3):565PubMedPubMedCentralGoogle Scholar
  72. Oe S, Togawa D, Yoshida G, Hasegawa T, Yamato Y, Kobayashi S, Yasuda T, Banno T, Mihara Y, Matsuyama Y (2017) Difference in spinal sagittal alignment and health-related quality of life between males and females with cervical deformity. Asian Spine J 11(6):959–967PubMedPubMedCentralCrossRefGoogle Scholar
  73. Ohara A, Miyamoto K, Naganawa T, Matsumoto K, Shimizu K (2006) Reliabilities of and correlations among five standard methods of assessing the sagittal alignment of the cervical spine. Spine 31(22):2585–2591PubMedCrossRefGoogle Scholar
  74. Okada M, Minamide A, Endo T, Yoshida M, Kawakami M, Ando M, Hashizume H, Nakagawa Y, Maio K (2009) A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine 34(11):1119–1126PubMedCrossRefGoogle Scholar
  75. Owens E (1990) Cervical curvature assessment using digitized radio-graphic analysis. Chiropractic Res J 4:47–62Google Scholar
  76. Pal GP, Sherk HH (1988) The vertical stability of the cervical spine. Spine 13(5):447–449PubMedCrossRefGoogle Scholar
  77. Papathanasiou A (2005) Health status of the Neolithic population of Alepotrypa cave, Greece. Am J Phys Anthropol 126(4):377–390PubMedCrossRefGoogle Scholar
  78. Pearson MP, Chamberlain A, Craig O, Marshall P, Mulville J, Smith H, Chenery C, Collins M, Cook G, Craig G, Evans JA, Hiller J, Montgomery J, Schwenninger JL, Taylor G, Wess T (2005) Evidence for mummification in bronze age Britain. Antiquity 79(305):529–546CrossRefGoogle Scholar
  79. Petit A, Bodin J, Delarue A, D’Escatha A, Fouquet N, Roquelaure Y (2018) Risk factors for episodic neck pain in workers: a 5-year prospective study of a general working population. Int Arch Occup Environ Health 91(3):251–261PubMedCrossRefGoogle Scholar
  80. Polly DW Jr, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS (1996) Measurement of lumbar lordosis: evaluation of intraobserver, interobserver, and technique variability. Spine 21(13):1530–1535PubMedCrossRefGoogle Scholar
  81. Prasarn ML, Baria D, Milne E, Latta L, Sukovich W (2012) Adjacent-level biomechanics after single versus multilevel cervical spine fusion. J Neurosurg Spine 16(2):172–177PubMedCrossRefGoogle Scholar
  82. Protopsaltis TS, Scheer JK, Terran JS, Smith JS, Hamilton DK, Kim HJ, Mundis GM Jr, Hart RA, McCarthy IM, Klineberg E, Lafage V (2015) How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. J Neurosurg Spine 23(2):153–158PubMedCrossRefGoogle Scholar
  83. Refshauge KM, Goodsell M, Lee M (1994) The relationship between surface contour and vertebral body measures of upper spine curvature. Spine 19(19):2180–2185PubMedCrossRefGoogle Scholar
  84. Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blonde B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19(2):141–159PubMedCrossRefGoogle Scholar
  85. Schultz AH (1961) Vertebral column and thorax. In: Hofer H, Schultz AH, Stark D (eds) Primatologia, vol 4. Karger, Basel, pp 1–46Google Scholar
  86. Shilton M, Branney J, Vries BP, Breen AC (2015) Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study. Chiropr Man Therap 23(1):33PubMedPubMedCentralCrossRefGoogle Scholar
  87. Simonsen JG, Axmon A, Nordander C, Arvidsson I (2017) Neck and upper extremity pain in sonographers–associations with occupational factors. Appl Ergon 58:245–253CrossRefGoogle Scholar
  88. Smith JS, Lafage V, Ryan DJ, Shaffrey CI, Schwab FJ, Patel AA, Brodke DS, Arnold PM, Riew KD, Traynelis VC, Radcliff K (2013) Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America myelopathy study. Spine 38(22S):S161–S170PubMedCrossRefGoogle Scholar
  89. Smith L, Louw Q, Crous L, Grimmer-Somers K (2009) Prevalence of neck pain and headaches: impact of computer use and other associative actors. Cephalalgia 29(2):250–257PubMedCrossRefGoogle Scholar
  90. Smith A, O’Sullivan P, Straker L (2008) Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine 33(19):2101–2107CrossRefGoogle Scholar
  91. Sonnesen L, Pedersen CE, Kjær I (2007) Cervical column morphology related to head posture, cranial base angle, and condylar malformation. Eur J Orthod 29(4):398–403PubMedCrossRefGoogle Scholar
  92. Tahara R, Motegi E, Nomura M, Tsuchiya Y, Shino T, Inoue E, Sueishi K, Matsuda I (2008) Curvature of cervical vertebra in 8020 achievers observed by lateral cephalogram. Bull Tokyo Dent Coll 49(1):15–21PubMedCrossRefGoogle Scholar
  93. Tornqvist EW, Hagberg M, Hagman M, Risberg EH, Toomingas A (2009) The influence of working conditions and individual factors on the incidence of neck and upper limb symptoms among professional computer users. Int Arch Occup Environ Health 82(6):689–702PubMedCrossRefGoogle Scholar
  94. Trinkaus E (1985) Pathology and the posture of the La Chapelle-aux-saints Neandertal. Am J Phys Anthropol 67(1):19–41PubMedCrossRefGoogle Scholar
  95. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, Baba H (2009) Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine 11(5):521–528PubMedCrossRefGoogle Scholar
  96. Visscher CM, Naeije M (1998) The relationship between posture and curvature of the cervical spine. J Manip Physiol Ther 21(6):388–391Google Scholar
  97. Wang VY, Chou D (2007) The cervicothoracic junction. Neurosurg Clin N Am 18(2):365–371PubMedCrossRefGoogle Scholar
  98. Yoon SY, Moon HI, Lee SC, Eun NL, Kim YW (2018) Association between cervical lordotic curvature and cervical muscle cross-sectional area in patients with loss of cervical lordosis. Clin Anat 31(5):716–723CrossRefGoogle Scholar
  99. Yu M, Zhao WK, Li M, Wang SB, Sun Y, Jiang L, Wei F, Liu XG, Zeng L, Liu ZJ (2015) Analysis of cervical and global spine alignment under Roussouly sagittal classification in Chinese cervical spondylotic patients and asymptomatic subjects. Eur Spine J 24(6):1265–1273PubMedCrossRefGoogle Scholar
  100. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T (2012) Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects. European Spine Journal 21(8):1492–1498.PubMedPubMedCentralCrossRefGoogle Scholar
  101. Zhu W, Sha S, Liu Z, Li Y, Xu L, Zhang W, Qiu Y, Zhu Z (2018) Influence of the occipital orientation on Cervical Sagittal Alignment: a prospective radiographic study on 335 normal subjects. Sci Rep 8(1):15336PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David Ezra
    • 1
  • Ella Been
    • 2
    • 3
  • Deborah Alperovitch-Najenson
    • 4
  • Leonid Kalichman
    • 4
  1. 1.School of Nursing ScienceTel Aviv Jaffo Academic CollegeTel Aviv-YafoIsrael
  2. 2.Department of Sports Therapy, Faculty of Health ProfessionsOno Academic CollegeKiryat OnoIsrael
  3. 3.Department of Anatomy and Anthropology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health SciencesBen-Gurion University of the NegevBeer ShevaIsrael

Personalised recommendations