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 Hutcheson with Dr. Ross Hauser discusses 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. 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 the 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 the 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 the 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

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:

• Cervical Spine Realignment
• Cervicogenic headaches: Migraines, tension headaches, and cervical spine instability
• Post-Traumatic Instability of the Cervical Spine
• Upper cervical instability and compression of the brainstem
• Cervical scoliosis
• Digital Motion X-ray: Finding the missing cause of headaches, dizziness, and facial pain
• Nausea and gastroparesis caused by cervical spine instability
• Treating Vertebrobasilar insufficiency – Bow hunter’s syndrome
• Cervical artificial disc replacement complications0
• Chronic Neck Pain and Blurred or Double Vision Problems
• Oscillopsia caused by cervical spine instability and neck pain
• Vestibular migraine and spontaneous vertigo – Migraine Associated Vertigo
• Cervical dystonia and spasmodic torticollis treatment
• Cluster headache treatment – cervical ligament instability and the trigeminal and vagus nerves
• Treatment of Whiplash associated disorders
• Can Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability?
• Can cervical spine instability cause heart palpitations and blood pressure problems?
• The evidence for non-surgical cervical radiculopathy treatments
• Post-cervical fusion migraines and neck pain0
• Cervical spine instability as a cause of your digestive disorders
• Ernest Syndrome – the answer to unresolved TMJ pain?
• When cervical spine instability causes ear pain, ear fullness, sound sensitivity, and hearing problems
• Mal de debarquement syndrome caused by cervical spine instability
• Cervical spine problems, Vagus nerve compression, as cause urinary incontinence
• Cervical disc disease and difficulty swallowing – cervicogenic dysphagia
• How cervical spine instability disrupts blood flow into the brain

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 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. 

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.