Cervical Sagittal Alignment and Clinical Outcomes in Chronic Neck Pain

Chronic neck pain is a common musculoskeletal problem associated with significant disability and reduced quality of life. Although structural and radiological parameters such as cervical sagittal alignment have been proposed as potential contributors to symptom severity, their association with clinical outcomes remains controversial. Altered body awareness, as assessed by the Fremantle Neck Awareness Questionnaire, represents an additional dimension that may influence symptom persistence and disability in these patients.

The aim of this study is to analyze the relationship between cervical sagittal alignment parameters, pain intensity, disability, and body awareness in patients with chronic neck pain. Eligible participants are adults aged 18-50 years with persistent neck pain for at least three months and who have undergone a lateral cervical X-ray within the last three months. Exclusion criteria include a history of cervical trauma or surgery, neurological or psychiatric disorders, inflammatory or systemic diseases, and conditions such as fibromyalgia or malignancy.

Pain intensity will be assessed using the Visual Analog Scale (VAS), disability with the Neck Disability Index (NDI), and body perception with the Fremantle Neck Awareness Questionnaire. Cervical sagittal alignment parameters will be measured retrospectively from the hospital's PACS system. By correlating radiographic findings with patient-reported outcomes, this study seeks to clarify the clinical relevance of cervical sagittal alignment and provide insight into its potential role in the management of chronic neck pain

Inclusion criteria

• Adults aged 18-600 years (inclusive), women and men

Chronic neck pain ≥3 months in duration

Lateral cervical X-ray performed within the past 3 months

Exclusion criteria

• History of cervical spine trauma or surgery

Cervical radiculopathy (history or current radicular neck/arm pain)

Systemic conditions: diabetes mellitus, inflammatory rheumatic disease, familial hyperlipidemia, malignancy, or fibromyalgia

Known neurological or psychiatric disorders