Permsak Paholpak, Andrew Vega, Blake Formanek, Koji Tamai, Jeffrey C. Wang, Zorica Buser

February 2021, Volume 30, Issue 2, pp 444 - 453 Original Article Read Full Article 10.1007/s00586-020-06559-5

First Online: 07 August 2020

Impact of cervical sagittal balance and cervical spine alignment on craniocervical junction motion: an analysis using upright multi-positional MRI


To evaluate the effect of cervical sagittal alignment on craniocervical junction kinematic.


We retrospectively reviewed 359 patients (119 cervical lordosis, 38 cervical sagittal imbalances, 111 cervical straight, and 91 cervical kyphosis) who underwent cervical spine multi-positional magnetic resonance imaging (mMRI). The C2-7 angle, disc degeneration grading and cSVA were analyzed in neutral position. The C3-5 OCI, O-C2 angle, and OCD were analyzed in neutral, flexion, and extension position. The Kruskal–Wallis test was used to detect difference among four groups. The post hoc analysis was performed by Mann–Whitney U test.


The cervical sagittal imbalance, cervical straight, and cervical kyphosis groups had significantly more lordosis angle in C3 and C4 OCI and O-C2 angle than the cervical lordosis group (p 


Cervical sagittal alignment affected craniocervical junction motion with the head exhibiting greater extension and motion in the cervical sagittal imbalance and cervical kyphosis groups. Motion of the head in relation to C2 can be used to predict the cervical sagittal alignment.

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