Cervical lordosis: the effect of age and gender

Been, Ella; Shefi, Sara; Soudack, Michalle

doi:10.1016/j.spinee.2017.02.007

Cited by 79 publications

(79 citation statements)

References 31 publications

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“…When the data were analyzed separately for each posture, we consistently observed significant differences in neck posture related to sex and height (which themselves are related in our sample) in all positions except neutral, supporting previous literature (Grob et al, ; Sonnesen et al, ; Cuccia et al, ; Been et al, ; Ezra et al, ). Notably, we observed no significant differences related to any factors in the neutral neck posture.…”

Section: Discussionsupporting

confidence: 90%

“…The well‐documented differences in mandibular shape between males and females (i.e., males have more angular gonial regions and protruding tuber omentale (mental eminence) (Krogman and Iscan, ; Huggare and Houghton, ; Ezra et al, ) may drive some of these observed differences, but these results clearly indicate that how neck postures are adopted is related to height and/or sex, likely as a function of the length of the cervical spine or the degree of lordosis cervicis. For example, males/taller individuals achieve neck flexion via increased flexion at the articulatio atlantooccipitalis, whereas females/shorter individuals achieve the same results by protruding their mandibles and also slightly increasing flexion at their remaining cervical vertebral joints (Been et al, ; Ezra et al, ). This could potentially indicate that males have increased flexion at the articulatio atlantooccipitalis because they do not have increased flexion there to begin with, whereas females do.…”

Section: Discussionmentioning

confidence: 99%

“…Lordosis cervicis (the natural forward curvature of the vertebrae in the neck region) in modern humans is related to a greater range of motion, while in neck flexion and extension compared to other primates and this morphology has been linked to the unique bipedal locomotion found in humans (Manfreda et al, ; Arlegi et al, ). Many authors have established that proper lordosis cervicis is essential for oral breathing (as opposed to nasal breathing), upright posture, a forward gaze, mastication, vocal production, and shock‐absorption during movement (Laskin et al, ; Straker et al, ; Young et al, ; Huggare and Houghton, ; Cuccia et al, ; Diebo et al, ; Been et al, ). There are significant differences in lordosis cervicis by sex, with females having greater lordosis at the topmost portion of the spine (Foramen magnum to C3) while male lordosis is greater at the base of the cervical vertebrae (C3‐C7) (Grave et al, ; Been et al, ; Ezra et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Many authors have established that proper lordosis cervicis is essential for oral breathing (as opposed to nasal breathing), upright posture, a forward gaze, mastication, vocal production, and shock‐absorption during movement (Laskin et al, ; Straker et al, ; Young et al, ; Huggare and Houghton, ; Cuccia et al, ; Diebo et al, ; Been et al, ). There are significant differences in lordosis cervicis by sex, with females having greater lordosis at the topmost portion of the spine (Foramen magnum to C3) while male lordosis is greater at the base of the cervical vertebrae (C3‐C7) (Grave et al, ; Been et al, ; Ezra et al, ). Loss of lordosis in many patients has been associated with neck and back pain, TMD, rapid maxillary expansion, an inability to maintain a horizontal gaze, malocclusion, and changes in growth patterns of the dentofacial and craniofacial regions (Lau et al, ; Shan et al, ; Silva et al, ; Festa et al, ; Grob et al, ; Sonnesen et al, ; Cuccia et al, ; Diebo et al, ; Been et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Sex and Height Influence Neck Posture When Using Electronic Handheld Devices

et al. 2019

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With increased tablet ownership in the United States comes increased levels of neck flexion compared to desktop or laptop computer use, and these neck postures have been linked to increases in neck pain. Importantly, tablet viewing postures can be achieved in multiple ways and could be determined by the morphology of the individual and/or other extraneous factors. In this study, we aim to preliminarily evaluate how neck postures vary during tablet use among individuals and link this variation to other factors such as sex, height, weight, presence/absence of temporomandibular joint disorder (TMD), and morphology of the head and neck. We analyzed two-dimensional landmarks placed on lateralview radiographs of 22 participants (10 female and 12 male) seated in neutral, upright, fully flexed, semi-reclined, and reclined postures. We utilize geometric morphometric techniques, which are advantageous for evaluating shape variation and have not been extensively applied to biomechanical analyses. We found skeletal morphology to be significantly related to sex and height in all but the neutral posture (P < 0.05), and weight was marginally significantly related to shape in the semi-reclined posture (P = 0.047). Morphologically, male participants exhibited more flexion at the articulatio atlantooccipitalis than females, and females showed greater mandibular protrusion than males, although this result is likely related to height. No relationship was found between posture and TMD. This research establishes a framework for future work that uses geometric morphometric analyses to evaluate how neck postures vary in relation to TMD.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex and Height Influence Neck Posture When Using Electronic Handheld Devices

et al. 2019

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“…Sex differences in growth have been determined (Been et al. ; Ezra et al. ), yet most clinical standards of cervical vertebral assessment continue to use unisex standards.…”

Section: Introductionmentioning

confidence: 99%

Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

et al. 2019

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The size and shape of human cervical vertebral bodies serve as a reference for measurement or treatment planning in multiple disciplines. It is therefore necessary to understand thoroughly the developmental changes in the cervical vertebrae in relation to the changing biomechanical demands on the neck during the first two decades of life. To delineate sex‐specific changes in human cervical vertebral bodies, 23 landmarks were placed in the midsagittal plane to define the boundaries of C2 to C7 in 123 (73 M; 50 F) computed tomography scans from individuals, ages 6 months to 19 years. Size was calculated as the geometric area, from which sex‐specific growth trend, rate, and type for each vertebral body were determined, as well as length measures of local deformation‐based morphometry vectors from the centroid to each landmark. Additionally, for each of the four pubertal‐staged age cohorts, sex‐specific vertebral body wireframes were superimposed using generalized Procrustes analysis to determine sex‐specific changes in form (size and shape) and shape alone. Our findings reveal that C2 was unique in achieving more of its adult size by 5 years, particularly in females. In contrast, C3–C7 had a second period of accelerated growth during puberty. The vertebrae of males and females were significantly different in size, particularly after puberty, when males had larger cervical vertebral bodies. Male growth outpaced female growth around age 10 years and persisted until around age 19–20 years, whereas females completed growth earlier, around age 17–18 years. The greatest shape differences between males and females occurred during puberty. Both sexes had similar growth in the superoinferior height, but males also displayed more growth in anteroposterior depth. Such prominent sex differences in size, shape, and form are likely the result of differences in growth rate and growth duration. Female vertebrae are thus not simply smaller versions of the male vertebrae. Additional research is needed to further quantify growth and help improve age‐ and sex‐specific guidance in clinical practice.

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