Relationship between alignment of upper and lower cervical spine in asymptomatic individuals

Kenya Nojiri, Morio Matsumoto, Kazuhiro Chiba, Hirofumi Maruiwa, Masaya Nakamura, Takashi Nishizawa, Yoshiaki Toyama

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100 Citations (Scopus)


Object. The aim of this study was to establish standard values for the normal alignment of the upper cervical spine and to clarify its relationship with the lower cervical spine in terms of alignment. Methods. Three hundred thirteen asymptomatic volunteers (155 men and 158 women) participated in this study. Lateral radiographs were obtained with the neck in neutral position, and the angles formed by the occiput (Oc) and the axis, the atlas and the axis, and C-2 to C-7 were measured. The mean Oc-C2 angle was 14.5 ± 8° in men and 16 ± 8.5° in women; the mean C1-2 angle was 26.5 ± 7° and 28.9 ± 6.7°, respectively; and the mean C2-7 angle was 16.2 ± 12.9° and 10.5 ± 10.3°, respectively. Although weak, statistically significant negative correlation was observed between Oc-C2 and C2-7 angles (r = -0.31 in men and -0.37 in women), and between C1-2 and C2-7 angles (r = -0.22 in men and -0.22 in women). The correlation coefficient between the Oc-C2 and C2-7 angles was greater than that between the C1-2 and C2-7 angles. Conclusions. Such relationships between alignment of the upper and lower cervical spines should be taken into consideration when performing occipitocervical fusion.

Original languageEnglish
Pages (from-to)80-83
Number of pages4
JournalJournal of neurosurgery
Issue number1 SUPPL.
Publication statusPublished - 2003 Jul 1


  • Cervical spine
  • Occiput
  • Spinal alignment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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