T1 slope and cervical lordosis

This is a continuation of our article Symptoms and treatments of spinal curvature problems. For many patients we see, who have issues of chronic pain and neurological symptoms, they come into the first visit us with an understanding that something is wrong with the curve of their neck and spine. They also have an understanding that it is this curve problem, whether their spines curve inwards too much or that they lost the natural curvature of the spine that is a cause of their problems.

T1 slope and cervical lordosis

In this video Dr. Brian Hutchison with Dr. Ross Hauser discuss the T1 slope and how it relates to problems not only of the neck but of the mid-spine and the lumbar spine.

Points: The C7/T1 Slope is the interface between the cervical spine and the thoracic spine. (The juncture of C7/T1).

At 0:30 of the video:

  • If the slope angle is too low, you will have a very flat curve spine, and a loss of curvature.
  • If the angle is too steep, your head will jut out forward ahead of the rest of your body and stress, not only the cervical spine but the mid-back thoracic spine and the lumbar spine.
In this still photograph from the video Dr. Hutch, a background illustration demonstrates that C7/T1 Slope is too low, you will have a very flat curve spine, and a loss of curvature. If the angle is too steep, your head will jut out forward ahead of the rest of your body and stress, not only the cervical spine but the mid-back thoracic spine and the lumbar spine.

In this still photograph from the video Dr. Hutcheson, a background illustration demonstrates that C7/T1 Slope is too low, you will have a very flat curve spine, and a loss of curvature. If the angle is too steep, your head will jut out forward ahead of the rest of your body and stress, not only the cervical spine but the mid-back thoracic spine and the lumbar spine.

At 0:40 of the video: Spinal curvature is not just a problem of the cervical spine.

  • A lot of people come in with neck problems and after a chiropractic examination, we may determine that we need to work more on their thoracic spine or their mid-back to fix their neck. Initially we may think this strange that to fix neck pain we would have to work on the lower aspects of the spine.

At 1:00 of the video: Dr. Hutcheson gives a demonstration of how adjustments to cervical spine may not help the patient until other areas of the spine need to be corrected.

  • (1:45 of the video) If you really look at the T1 slope initially we can put together the whole picture and find out where we need to address the patient’s pain first and end up getting the results we want.

Research: problems of cervical spine curvature should not be limited to correcting the curve just in the neck, but the whole spine should be addressed.

A March 2020 study in the Journal of spine surgery(1) offered surgeons this assessment of the problems of the spinal slope and curves and why surgical outcomes may be poor.

“Over the past decade, there has been growing interest in the sagittal (the line that runs down the body that separates the body into the left side and the right side) alignment of the cervical spine and its correlation to clinical (surgical) outcomes.”

Listen to the next part, the research suggests that problems of cervical spine curvature should not be limited to correcting the curve just in the neck, but the whole spine should be addressed.

“It is now known that cervical lordosis is not universally physiological and should not be pursued in all patients undergoing surgery. (In other words, correcting the cervical curve with surgery may not work if you do not address the whole spine.) Rather, it is increasingly understood that it is how these angular parameters (lordosis (excessive inward curve of the spine) or kyphosis (a hunchback condition) interact with translational parameters (how a body moves in motion) that is reflective of overall cervical spine and whole spine balance, which in turn impacts patient outcomes.”

In September 2020 a paper in the Journal of orthopaedic surgery and research, (2) also described the problem of poor surgical outcomes in the setting of cervical kyphosis.

“Cervical sagittal alignment is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis. In this study, the researchers evaluated the influence of cervical sagittal parameters on the development of axial neck pain in patients with cervical kyphosis.

Of the 263 patients in this study with cervical kyphosis the most common symptoms of axial neck pain were:

  • neck pain,
  • stiffness,

The following radiographic parameters were evaluated: cervical kyphosis types,

  • C2-7 sagittal vertical axis (the distance from the posterosuperior corner of C7 to a vertical line from the center of the C2 vertebra),
  • thoracic inlet angle ( a line connecting the center of the T1 vertabrae upper endplate and the upper end of the sternum),
  • T1 slope, a critical component of pelvic and lumbar lordosis
    • Explanatory note: A 2013 study (3)  suggested that The T1 slope is a landmark of an overall spinal sagittal balance and is a critical issue as the relationship between pelvic incidence and lumbar lordosis.
  • neck tilt (please see our article on Cervical dystonia and spasmodic torticollis treatment),
  • Cranial tilt, and cervical tilt.
  • Sagittal alignment of cervical kyphosis was classified into 2 types: global  (total spine centered) and regional (cervical area) type.

Results: Patients who complained of axial neck pain were categorized as the axial neck pain group while those without axial neck pain were categorized as non-axial neck pain group.

  • The T1 slope and C2-7 sagittal vertical axis in the axial neck pain group were significantly greater than that in the non-axial neck pain group. (These) findings suggest a significant effect of cervical sagittal parameters on the occurrence of axial neck pain in patients with cervical kyphosis. Greater T1 slope and larger C2-7 sagittal vertical axis may lead to the development of neck pain.

The curvatures of the neck

In our practice we see problems of cervical spine instability caused by damaged or weakened cervical spine ligaments. With ligament weakness or laxity, the cervical vertebrae move out of place and progress into problems of chronic pain and neurological symptoms by distorting the natural curve of the spine. This illustration demonstrates the progression from Lordotic to Military to Kyphotic to "S" shape curve.

In our practice we see problems of cervical spine instability caused by damaged or weakened cervical spine ligaments. With ligament weakness or laxity, the cervical vertebrae move out of place and progress into problems of chronic pain and neurological symptoms by distorting the natural curve of the spine. This illustration demonstrates the progression from Lordotic to Military to Kyphotic to “S” shape curve.

At 2:10 of the video: Dr. Hauser discusses Prolotherapy in helping to correct slope angles and the problems of neck pain.

Prolotherapy treatment

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. We are going to refer our 2014 study where we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments.

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

For Prolotherapy treatment information more specific to your symptoms, please visit these article as they relate to you:

In this illustration we can see what happens when the C7 slope becomes too steep and the head moves forward. Stretching or ligament looseness or laxity can cause the problems of head forward position as head forward position can cause further dames to the cervical spine ligaments. It is a cause and effect cycle, you have head forward because of weak ligaments and you have weak ligaments because of forward head posture, the stresses of this problem are manifest at the C2-C7 vertabrae. 

In this illustration, we can see what happens when the T1/C7 slope becomes too steep and the head moves forward. Stretching or ligament looseness or laxity can cause the problems of head forward position as head forward position can cause further dames to the cervical spine ligaments. It is a cause and effect cycle, you have head forward because of weak ligaments and you have weak ligaments because of forward head posture, the stresses of this problem are manifest at the C2-C7 vertebrae. 


Repairing the ligaments and curve for a long-term fix

The goal of our treatment is to repair and strengthen the cervical ligaments and get your head back in alignment with the shoulders in a normal posture. In this illustration we see the before an after of neck curve corrections. Ligament laxity or looseness or damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of head and chest weights, documented below.

In this illustration, we see the before and after of neck curve corrections. Ligament laxity or looseness or damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of head and chest weights.

At the start of this article, we stated that few people contact us describing their problems as one of a loss of spinal curvature. What they do contact us about is the many symptoms they are suffering from including chronic pain and neurological symptoms.

 Get help and information from Caring Medical

References

1 Teo AQ, Thomas AC, Hey HW. Sagittal alignment of the cervical spine: do we know enough for successful surgery?. Journal of Spine Surgery. 2020 Mar;6(1):124. [Google Scholar]
2 Li J, Zhang D, Shen Y. The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis. [Google Scholar]
3 Park JH, Cho CB, Song JH, Kim SW, Ha Y, Oh JK. T1 slope and cervical sagittal alignment on cervical CT radiographs of asymptomatic persons. Journal of Korean Neurosurgical Society. 2013 Jun;53(6):356.  [Google Scholar]

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