ORIGINAL RESEARCH
A Demographic and Physical Characterization
of Cervical Spine Curvature
and Degeneration
Michael Shaikewitz, D.C.
Introduction
While numerous studies have described loss of lordosis of the
cervical spine and the stages of spinal degeneration,1-6 the
emphasis has been primarily directed toward these conditions as
a result of trauma or other pre-disposing pathological condi-
tions. Although the process of spinal degeneration, primarily as
osteoarthritis, and spinal curvature have been investigated,7,8 the
present author was unable to reference through the literature
any specific characterization of cervical spine lordosis and cervi-
cal spine degeneration, regardless of etiology, coupled with
demographics including such variables as age, gender, and occu-
pation.
As the consequences of these conditions have been well doc-
umented, often being linked to vertebral subluxation,3 it is
important to contribute to their etiologic basis by first describ-
ing their occurrence within the general population. In this
regard, the present investigation was conducted as a preliminary
study to evaluate the association between categories of cervical
curvature and stages of cervical spine degeneration within a ran-
domly selected population.This study was designed as a first step
in assessing the relevance between cervical lordosis, degeneration,
and specific demographic features of the population at large.
Methods and Materials
Subjects and Study Setting
All potential subjects for the study were first contacted by
random selection from a local telephone directory to query their
willingness to participate. The first 188 Volunteers were then
scheduled for radiographic assessment and completion of a
Spinal Research Survey. Prior to their participation, each volun-
teer was interviewed and required to read and sign an informed
consent which included full disclosure of the nature of the study.
In order to enhance the randomness of the population, no
exclusionary factors were considered.The study was conducted
in the private office setting over a period of 15 months, from
October of 1992 through December of 1993.The study group
consisted of 75 males and 113 females ranging in age from 13 to
84 years. A demographic description of the study population is
presented in Table 1.
Address reprint request to: Michael Shaikewitz, D.C., 3029 N.Alma
School Rd., Suite 108, Chandler, AZ 85224.
Characterization of Spinal Curve and Degeneration
Radiographic Assessment
An 8x10 inch neutral laeral radiograph was taken of each
subject in a natural standing position.The beam of the x-ray was
directed to the 5th cervical vertebra.The subjects chin was posi-
tioned such that the hard palate was parallel to the floor, or with
a slight tilt. A tube distance of 76 inches was employed consis-
tently for each subject. One x-ray, per subject, was taken by the
author with a 240 volt, 60 Hz, 135 amp Model 3120 Adtek x-
ray system (Adtek Systems, Los Angeles, CA).
Cervical Spine Curvature
Spinal curvature was determined by constructing an arc line
between the posterior aspect of the anterior tubercle of the first
cervical vertebra (C1) and anterior tip of the body of the sec-
ond thoracic vertebra (T2). When constructed, the arc consti-
tuted part of an imaginary circle with a radius of 17 cm, which
is considered normal.9 The anteriorly directed arc was con-
structed for each radiograph with an Acu-Arc Ruler (Hoyle
Engineering Company, Filmore, CA), and the cervical curve
radius was determined by this procedure and recorded.
To insure that choice of method was not a variable, a radi-
ograph of a typical 17 cm radius cervical spine was analyzed by
the method of Yochum and Rowe,10 which reflected a cervical
angle of 40 degrees, also considered to be the average normal
cervical spine curvature.
A range of cervical curves was considered, according to the
radius of the arc: The categories were defined as follows: The
normal lordotic curve (NLC) reflecting a 17 cm radius (1), the
hypo-lordotic curve approaching a straight line (HLC) repre-
senting cervical curves of radius greater than 17 cm (2), no arc
(SCS) representing a straight cervical spine (3), and the reversed
cervical curve (RCC) reflecting curvature that had become
kyphotic, with a reversed arc of radius 17 cm or greater. A fifth
category, hyper (extended)-lordotic curve (ELC), characterizing
a curve with an arc less than 17 cm in the lordotic direction was
recognized but never observed in the study. Consequently, the
range of cervical curves were categorized as being 1 - 4.
Spinal Degeneration Phases
The radiographs of all subjects were categorized into phases
of spinal degeneration by the author, a practitioner with exten-
sive experience in radiographic evaluation. The phases are a
JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 1
 Table 1 Demographic Profile of the Subject Population

Variable Categories Number Percent Respondents Descriptors

Gender Male 75 40.0 188 Majority

Female 113 60.0 Female

Age 18 - 24 14 7.5 188 Mean

25 - 44 107 56.9 (42.015.2)
45 - 64 45 23.9 Median
65 22 11.7 (38)

Race/ Anglo/Caucasion 156 83.0 184

Ethnicity Hispanic 19 10.1
Black 3 2.0 -
Asian 3 2.0
Native American 3 1.1

Household $12,000 22 12.0 149 Estimate

Income $12,000-$19,000 41 22.0 Median Income
$20,000-$34,000 53 28.0 ($20,000-$34,000)
$35,000-$59,000 32 17.0
$60,000 1 1.0

Marital Single, never married 26 14.0 186 Majority Married

Status Single, sep/divorced 32 17.0
Single, widow(er) 9 4.8
Married 119 63.0

Education Grade School 3 1.6 187 Majority with

High School 32 17.0 education beyond
College/Trade Sch. 99 53.0 High School
College Graduate 35 19.0
Masters Degree 15 8.0
Doctoral Degree 3 1.6

Occupation Managerial/Prof. 45 24.0 188

Technical/Admin. 41 21.8
Service (clerical) 15 8.0
Craftsman/Skilled 11 5.9
Operators/Labor 7 3.7
Home-makers 19 10.1
Student 13 6.8
Retired 17 9.0
Unemployed 8 4.3
Other 12 6.4

modification of those described by Ressel3 with regard to the
structural integrity of the osseous tissue and vertebral disc space
relationships. In the present study, Phase 1, as depicted on x-ray,
represented a cervical spine in which there was no apparent
degeneration.The edges and the margins of the vertebrae were
smooth and regular with joint surfaces evenly spaced. Phase 2
represented a cervical spine in which a mild degree of degener-
ation was observable on x-ray. This included rough vertebral
margins, often accompanied by irregular joint surfaces and
osteophyte formation with visible decrease in disc space height.
Phase 3 spinal degeneration was characterized by a more pro-
nounced depiction of Phase 2. That is, vertebral margins were
often rough to the point of being jagged. Facet joint surfaces
were sclerotic with extensive spurring and disc degeneration
(Figures 1-3). Phase 4 presented radiographic evidence of fusion
of one or more adjacent segments accompanied by extensive
osseous and disc degeneration.
Survey Instrument
The questionnaire section of the Spinal Research Survey
included two sections.The first section, completed by the chiro-
practor, consisted of descriptions and classifications regarding the
status of the cervical curve and extent of cervical spine degen-
eration.The second section, completed by the subject, consisted
of 7 demographic questions, the results of which are reported in
Table 1.

2 JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 Characterization of Spinal Curve and Degeneration
 Table 2 Percent Distribution of Cervical Curve Types
as a Function of Gender and Total Subject Population*
Males
(N=75)
Curve Type
1 8.0
2 38.7
3 24.0
4 29.3
* Means differences between genders was determined by Anova, P<0.05. Gender and curve types also showed a
significant positive correlation (Pearson correlation matrix, P<0.05).
Statistical Analyses
All radiographs and questionnaires were number coded.
Collation of the questionnaire responses and radiographic analy-
ses were conducted independent of one another. Statistical
analyses involved characterizing the subject population by per-
cent distribution relative to gender, age, ethnicity, household
income, marital status, education and occupation. From the
demographic data, gender, age, and occupation were analyzed to
ascertain the extent of correlation or other association to cervi-
cal curve and phase of degeneration findings. Analyses included
Pearsons Chi Square, Pearsons Correlation Matrix, and
Multiple Analysis of Variance (ANOVA). Fishers paired compar-
ison test of least significance, and Multiple Regression.11
Significance was expressed at P < 0.05.
Results
Subject Population
Table 1 presents the percent distribution of 188 subjects
according to gender, age, ethnicity, household income, marital sta-
tus, education, and occupation. In certain categories either or both
1990 U.S. census report (CR)12 and population statistics from a
1993 study of unconventional medicine in the United States
(UMUS)13 which were reported to be similar to the U.S.
National Health Interview Survey were used for comparison.
In regard to these comparisons, the subject population was
composed of more females than males.The 60:40 proportion of
females to males reflected approximately 9% more females in the
subject population than in the U.S. population and 12% more
females than the UMUS study.
While subjects ranged in age from 13 to 84 years, the medi-
an age was 38 compared to 33 for the U.S. population.
Distribution over different age categories was similar, but varied
according to whether the study population was compared to the
CR or the UMUS study. The percentage of those between 18
and 24 years was below both the CR and the UMUS study by
5% and 10%, respectively. The group ranging from 25 to 44
years was above the CR by 25%, but within 6 % of the UMUS
study for the 25 to 34 plus 35 to 49 year age groups.The 45 and
older group was within 4 % of the same grouping compared to
the CR, and within 1% of the UMUS group of 50 and older. It
Characterization of Spinal Curve and Degeneration
Female Total
(N=113) (N=188)
%
0.0 3.2
30.1 33.5
30.1 27.7
39.8 35.6
is apparent that different studies encompassing different demo-
graphics report similar age distributions, but do vary from one
another and the U.S. census report.The age categories present-
ed in Table 1 were considered to be similar to the CR and/or
the UMUS study.
In terms of ethnicity, the subject population was 83%
Anglo/Caucasian compared to the CR of 80% and the UMUS
distribution of 82%; 2 % Black compared to the CR of 12% and
the UMUS of 9%; 1% Native American as compared to the CR
of 0.8%; 10% Hispanic compared to the UMUS of 6%; and 2%
Asian compared to 1% reported in the UMUS.
Approximately 62% of the subject pool fell within the range
of < $20,000 to $34,000 income as compared to 64% of the
subject population in the UMUS report for the same range.
Education was not readily comparable to the other indices, as
they also lack standardization. In the present study the vast
majority, 82%, were educated above the high school level. Of the
total number, approximately 20% were college graduates and
10% had completed graduate studies.
Regarding occupations, the present study considered two
approaches. In one comparison, subjects were grouped similar to
the CR, since the UMUS did not consider occupations. The
present subject population was approximately 10% higher than
the CR relative the occupation of managerial/professionals, and
about 10% lower regarding laborers. The other categories were
within 1% to 3%, although there were no representatives of the
farming, fishing occupations in the subject population.
Unfortunately, the CR did not consider such categories as
homemaker, student, retired or unemployed. Since approximate-
ly 40% of the present subject population comprised categories
not listed in the CR, another index was devised which includ-
ed these as well as the occupations listed in the CR.This occu-
pation categorization resulted in a distribution which was clos-
er to the managerial/professional CR (24% vs 26%), but lower
in every other category. Nevertheless, this arrangement was cho-
sen for the present study since it best represented the subject
population (Table 1).
Cervical Curvature Within the Subject Population
Demographic and other categories evaluated as independent
variables affecting cervical curvature included degeneration
JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 3
 Table 3 Percent Distribution of Cervical Curve Types as a Function of Age Ranges*

Curve Types

1 2 3 4

Age Ranges N %
(years)

1. 18-24 14 0.0 8.3 25.0 66.7

2. 25-44 107 1.9 33.6 25.2 39.3
3. 45-64 45 8.9 33.3 31.1 26.7
4. > 64 22 0.0 52.4 28.5 19.1

* Age ranges showed significant negative correlation with curve type (Pearson correlation matrix, P<0.05).
Analysis of variance and Fishers least significant difference test also revealed that the means of the age ranges
were significantly different among the different curve types (P<0.05).

phase, gender, age range, and occupation collectively and singly.
Consideration, by step-wise multiple regression analysis, of the
influence of gender, age, occupation, and degeneration phase as
collective factors revealed that gender and age served as predic-
tors of cervical curve (P= 0.009, gender and P= 0.012, age
range). Additionally, when these parameters were evaluated
singly, only gender and age range were significant variables asso-
ciated with cervical curvature.Tables 2 and 3 show the distribu-
tion of cervical curve types 1 through 4 as a function of gender
and age range respectively. It should be noted that step-wise
multiple regression analysis also indicated that gender and age
range only accounted for 58% of the prediction value of cervi-
cal curvature. Therefore, with the elimination of degeneration
phases, and occupations, it is evident that factors other than gen-
der and age range are involved as predictors of cervical curva-
ture.
Curve types were significant relative to gender (chi square =
0.007), expressing a positive correlation (P < 0.05).That is, curve
types 1 and 2 were more frequently observed in males than
females, and type 3 and 4 more frequently observed in females.
Age range significantly influenced the four curve types
(Anova, P= 0.042). Multiple regression analysis (P = 0.012)
revealed that age range was negatively correlated to cervical
curve type as depicted in Table 3. That is, curve types 1 and 2
were more frequently reported among age groups ranging from
45 and above, while curve types 3 and 4 were more common
among age groups ranging from 18 through 44 years.
Spinal Degeneration Phases Within the Subject Population
Three phases of cervical spinal degeneration were identified
among the subject population (Figures 1-3). Phase 4, primarily
characterized by fusion of cervical segments, was not observed
in any of the subjects.
Demographic variables including curve type, gender, age
range, and occupation were evaluated collectively by step-wise
multiple regression for their respective influence on spinal
degeneration phases. Among these parameters, age range (P =
0.00) was revealed as a predictor of spinal degeneration. When
evaluated singly by Anova and Fishers least significant difference
analysis, occupation and age range, were significant. Pearsons
correlation matrix also showed a significant correlation between
the independent variables of occupation and age against degen-
eration phase (P < 0.05), but not for gender. Tables 4 and 5,
respectively, show the percent distribution of spinal degenera-
tion phases 1-3 as a function of occupation and age range. As
with cervical spinal curvature, step-wise multiple regression
analysis indicated that the significant variables accounted for
only 40% of the prediction value for spinal degeneration.
Therefore, it is evident that factors other than those studied are
involved as predictors of cervical spine degeneration.
Occupation, when tested singly as a predictor of degenera-
tion phase by an Anova, was significant (P = 0.008).The percent
distribution of degenerative phases as a function of occupations
is presented in Table 4. It was apparent from the data that the dis-
tribution between three degeneration phases was different
among the various occupations. It was also apparent, however,
that six of the nine occupations represented expressed degener-
ation phases in the same order. That is, Phase 2 > Phase 1 >
Phase 3. The other category was not tabulated since it was not
clear what type of occupation(s) were represented. Among the
group of six occupations, the greatest degree of degeneration
(Phase 3) represented only a small percent of the total category,
ranging from 0.0% to 15.7%. Although Phase 2 degeneration
prevailed among the group of six, Phase 1 (essentially a normal
structural spine), ranged from 11% to 45% among the occupa-
tions. Phase 2 degeneration ranged from 60% to 86.7% among
this group. The three remaining occupational groups each
expressed a different order of magnitude for the three Phases of
degeneration.That is, Phase 1 prevailed in one group, Phase 2 in
another, and the Phase 3 in the remaining group.Therefore, out
of nine occupations tabulated (Table 4), seven expressed Phase 2
as the predominant degeneration phase. It is noteworthy, that
only one group was represented by a predominant expression of
Phase 3 degeneration (71%), and one group by a predominant
expression of Phase 1(57%).
It is beyond the scope of this paper to speculate why any par-
ticular occupation would be linked to a specific degeneration
phase. However, it is evident that the majority of occupations,

4 JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 Characterization of Spinal Curve and Degeneration
 regardless of their features, were significantly associated with the tion of cervical curve and
appearance of three phases of cervical spine degeneration in a degeneration phase among a
specific order of magnitude. It is also noteworthy that only two small population of subjects pre-
groups (one each) were characterized by the predominant liminary to a more global inves-
expression of Phase 1 or Phase 3 degeneration. tigation.
When degeneration phases were evaluated against age ranges
as the independent variable (Table 5), it could be seen that Phase Limitations of the
3 and Phase 1 degeneration were inversely related to the age Subject Population
groupings. Age ranges below the 45-64 group were predomi- The results of the present
nantly Phase 1, while those above the 25-64 age group were study are based on findings from
predominantly Phase 3.The 25-44 age group appeared to be the a population that can be charac-
transition group, exhibiting predominately Phase 2. terized as follows: 60% female,
Since it was observed that age range and occupation were median age of 38 years (mean 42
significant factors influencing cervical spine degeneration phas- 15.0), 80% Anglo/Caucasian,
es, the distribution of actual number of subjects in the various 63% married, median annual
age ranges among the various occupations was investigated. income of $20,000 - $34,000,
Table 6 shows the group of six occupations, described above. It Figure 1 moderate to well educated, and
can be seen that the age range of 18-24 varied among the group representing 9 recognized occu-
of six from 0.0 to 30 and that age range from 45 and above var- pations ranging from skilled
ied from 0.0 to 14. The putative transition age group of 25- professional to laborer. While
64 years (Table 5) ranged from 0.0 to 30.0 subjects.The first of the population compares simi-
the three occupations outside of the group of six showed an larly to the U.S. census report
even distribution of subjects according to age range, the second and the UMUS study, it is
showed a predominance in the 25-44 year age category, while important to point out that the
the third group showed a predominance of age range above 45 results may be unique to the
years. Of these three groups, the first expressed a predominance population studied. Several fac-
of Phase 1 degeneration, the second Phase 2 degeneration, and tors necessitate this caution.
the third Phase 3 degeneration (Table 5). Although subjects were
obtained through a random
Cervical Spine Curvature and Spinal Degeneration Phases identification process, the first
In the subject population of the present study, four types of 188 respondents constituted the
cervical spine curvature and three phases of spinal degeneration study group. Consequently, no
were observed.As seen in Table 2, among the subject population assessment was made of non-
Figure 2
as a whole, curve type 4 was the most prevalent (35.6%), fol- respondents. It is possible, there-
lowed closely by 2 (33.5%). Curve type 3 was 27.7% while curve fore, that participants represent-
type 1, which has been viewed as the normal cervical curve, ed a select group with charac-
was the least prevalent among the 188 subjects (3.2%). Cervical teristics different from the pop-
curvature was significantly correlated to gender (P = 0.009), and ulation at large. Secondly, the
age range (P = 0.012). number of subjects was small
The three degeneration phases, when evaluated against the and gender and age biased. This
subject population as a whole, revealed that Phase 2 predomi- resulted in several of the cate-
nated (68.2%), compared to Phase 1 (16.4%) and Phase 3 gories evaluated having a small n
(15.4%), which were essentially equal.While the distribution in value, which when coupled to
the subject population of degeneration phase 2 was greater than the gender and age bias, could
Phase 1 or 3, there was no apparent difference between the dis- increase the chance of mis-
tribution of Phases 2 and 3. Additionally, there was no signifi- interpreting statistical relation-
cant difference between gender and degeneration phase. ships. With these cautions in
Degeneration phases did show positive correlation to age range mind, however, the findings of
(P = 0.000) and occupation (P = 0.008). this particular population are of
Of interest, when cervical curvature and spinal degeneration Figure 3 interest, raising several questions
phases were analyzed statistically, no significant relationship Figures 13. The radiographs repre- worthy of further study.
between the two variables was detected when considering chi sent phases of degeneration as
square, multiple regression analysis, or Pearsons correlation described in the study. Figure 1 Interrelating Variables, Spinal
matrix.That is, spinal curvature was not found to be a predictor depicts Phase 1 cervical degenera- Curves and Phases of Degeneration
tion, Figure 2 represents Phase 2
of spinal degeneration phases or vice versa. In the present study, cervical
degeneration, and Figure 3 shows
Phase 3 cervical degeneration. All spine degeneration phases and
Discussion radiographs are from subjects in spinal curvature were indepen-
The present pilot study was conducted to assess the distribu- the present study. dently related to other variables.

Characterization of Spinal Curve and Degeneration JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 5
 Table 4 Percent Distribution of Degeneration Phases as a Function of Occupations*

Degeneration Phases
1 2 3
Occupations N %

Operators, Laborers 7 57.1 42.9 0.0

{1,2,3}
Unemployed 8 12.5 62.5 25.0
{2,3,1}
Retired 17 0.0 29.4 70.6
{3,2,1}

Managerial/Professional 45 8.9 86.7 4.4

{2,1,3}
Crafsmanship/Skilled 11 18.2 81.8 0.0
{2,1,3}
Student 13 23.1 76.9 0.0
{2,1,3)
Technical/Sales/Administration 41 17.1 73.2 9.7
{2,1,3}
Home-makers 19 21.1 63.2 15.7
{2,1,3}
Service (table waiting, etc.) 15 26.7 60.0 13.3
{2,1,3}

* Mean differences of occupations distributed over the three degeneration phases showed significant variance (Anova),
P<0.05, (Fishers LSD, P<0.05), as well as significant positive correlation (Pearson correlation matrix, P<0.05).
Certain occupations are boxed to highlight the consistency of degeneration phases. Each occupation in the box
showed degeneration phase 2 more prevalent than 1, which was more prevalent than 3. The first three occupations
exhibited other patterns {exhibited in brackets} but still varied significantly in their means.

Interestingly, degeneration phases and spinal curvatures were not
significantly correlated. The importance of this finding relates
directly or indirectly to various classifications of spinal degen-
eration3,14 and various vertebral subluxation correction tech-
niques,15 many of which speculate that certain curvatures pro-
mote or are otherwise associated with spinal degeneration.
While, in any particular case, spinal curvature may be related to
a specific phase of degeneration, the present study suggests that
there is generally no predictive value of cervical curve type to
degeneration phase, or vice versa. Considering results of the pre-
sent study which revealed the same likelihood of occurrence of
any phase of cervical spine degeneration in association with any
type of cervical curve, it seems plausible that cervical curvature
may primarily be a biomechanical adaptive response linked to
age, gender, and other factors in a manner which does not nec-
essarily predispose the individual to degenerative processes.
The influence of gender was related to cervical curvature but
not degeneration phase. The positive correlation between gen-
der and curvature suggested that females in the study were more
likely to express curve type 3 followed by curve type 4. Curve
types 3 and 4, respectively, represented the straight or military
spine versus a reversed or kyphotic cervical spine with a radius
of no greater than 17 cm. Males, alternatively, were more likely
to exhibit spinal curvature type 1 which represented the nor-
mal lordotic curve of 17 cm radius, followed by a spine with
greater than a 17 cm radius but less than straight, designated as
curve type 2. Since most data gathered on the comportment of
spinal curvature types has been done with patients also exhibit-
ing degenerative changes, there exists no comparison to assess
this phenomenon across a broader number of subjects. To the
knowledge of these authors, this is the first study to implicate
the influence of gender on cervical spine curvature.
It is also noteworthy that among the subject population as a
whole, the most predominant spinal curve types were 2 and 4 in
almost identical percent distributions. When this information is
combined with the findings regarding age ranges, a pattern
emerges. Curve types and age ranges were inversely correlated,
suggesting that higher age ranges expressed curve types 1 and 2
more frequently than lower age ranges, which expressed curve
types 3 and 4 more frequently. Other than in individual cases,
the general perception that the normal cervical curve (Type 1)
would more likely be found in lower age groups, or, conversely
least likely to be found in higher age groups, is dispelled by these
findings. It appears in the population studied that the straight or
military neck and kyphotic or reversed cervical curve were
more common in age groups ranging from 18 through 44 years,
with the lordotic curve more common among those greater
than 45 years.
Both gender and age range appeared to independently influ-
ence curve type as gender and age range were not related.

6 JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 Characterization of Spinal Curve and Degeneration
 Table 5 Percent Distribution of Degeneration Phases as a Function of Age Ranges*

Degeneration Phases

1 2 3

Age Ranges N %
(years)

1. 18-24 14 91.7 8.3 0.0

2. 25-44 107 16.8 79.4 3.8

3. 45-64 45 0.0 75.6 24.4

4. > 65 22 0.0 38.1 61.9

* Age ranges were positively correlated with degeneration phase (r=0.64), and means for the different age ranges
were significantly different as determined by Anova, P<0.05.

However, phases of spinal degeneration were influenced by both
age range and occupation, but not gender.The pattern of spinal
degeneration relative to age range suggests that higher age
groups were more likely to express a greater degree of cervical
spine degeneration. This observation is consistent with other
reports linking osseous degenerative processes with age.5,7
The present study also links occupation to cervical spine
degeneration. A strong relationship was seen in the retired
group, of which 71% were in phase 3 degeneration which was
characterized by marked osseous deterioration, disc narrowing,
and osteophyte formation.The coupling to age is no surprise as
the majority of subjects in this group belonged to the greater
than 65 age group.Alternatively, the occupational group exhibit-
ing the highest level of Phase 1 degeneration (essentially a nor-
mal spine), were those involved in labor. When related to age
range, however, it was observed that this category was comprised
equally of 18 through 64 year olds.This suggests that when age
is considered alone, a higher level of degeneration is predicted,
but when coupled with a particular occupation, the relationship
between age and cervical spinal degeneration may be altered.
Although it is beyond the scope of this study to ascertain what
aspects of an occupation may be operative in its effects, it appears
that among individuals performing the occupation of labor
the higher age effect on degeneration phase may be offset. A
similar pattern emerges in respect to occupations in which sub-
jects expressed a high percentage of degeneration phase 2 (mod-
erate degeneration) of at least three to four times the prevalence
of either phase 1 or 3. In the seven occupations showing a high
percentage of phase 2 degeneration the ratio of ages favored the
25-64 range, as was predicted by the age - degeneration statisti-
cal relationship. However, it was also observed that the ratio of
higher age subjects was greatest in the occupation
(Managers/Professionals) which expressed the greatest preva-
lence of phase 2 degeneration. As the prevalence of phase 2
decreased among the seven occupations, it was further observed
that the number of subjects in the higher age ranges (greater
than 45 years) varied.This also suggests, as described above, that
some occupations may couple with age to offset the degenera-
tive process, while others appear to express a positive correlation
between age and degeneration.
The present study has revealed certain relationships which
appear to either substantiate or bring into question perspectives
regarding the relationship between gender, age and occupation
as related to cervical spinal curvature and phase of cervical spine
degeneration. In order to further assess the relationships present-
ed in this study it will be necessary to evaluate a larger popula-
tion, adhering to stringent protocols for reducing bias among
the variables, and evaluating non-respondents. It will also be of
interest to further investigate the interaction between the nature
of certain occupations as coupled to age and degeneration, as it
is apparent that factors other than those investigated are involved
in the expression of a particular cervical curve type as well as
degeneration phase.
Summary and Conclusions
In relation to the findings of the present study, the following
conclusions have been drawn:
1. The subject population, while similar to other study pop-
ulations and the U.S. census report of 1990, represents a unique
profile of subjects, which must be extrapolated with caution to
the population at large.
2. Cervical spinal curvature is not related to phase of cervical
spine degeneration. Consequently, cervical spine curvature may
reflect a biomechanical adaptive phenomenon linked to age,
gender, and other variables, but not necessarily a predisposing
factor of cervical spine degeneration.
3. Cervical spine curvature is influenced by gender and age
range.The more normal curve types 1 and 2 are more preva-
lent among males while the straight to kyphotic types 2 and 3
are more prevalent among females.These same curve types were

Characterization of Spinal Curve and Degeneration JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 7
 Table 6 Number of Subjects Per Age Range in Various Occupations*

Age Ranges (years)

18-24 25-44 45-64 >65
N (14) (107 (45) (41)

Occupations N Number of Subjects

Operators, Labor 7 2.0 3.0 2.0 0.0

Unemployed 8 0.0 6.0 1.0 1.0

Retired 17 0.0 1.0 4.0 11.0

Managerial/Professional 45 0.0 30.0 14.0 1.0

Crafsmanship/Skilled 11 1.0 8.0 1.0 1.0

Student 13 4.0 10.0 0.0 0.0

Tech/Admin. 41 4.0 30.0 8.0 0.0

Home-makers 19 1.0 11.0 5.0 2.0

Service (clerical) 15 2.0 6.0 3.0 3.0

* Numbers represent the actual number of subjects reporting a particular occupation. For example, 16.7% of age range
18-24 were operators/labor.The actual number is 2, since there 14 subjects in the group.

inversely related to age range, with the age ranges of 18 - 44 pri-
marily exhibiting curve types 3 and 4 and age ranges of 45
through greater than 65 exhibiting curve types 1 and 2. Since
age range was not correlated to gender, these factors appear to
independently influence curve type.
4. Spinal degeneration Phases were influenced by age range
and occupation.The more normal phase one was more preva-
lent in the lower age range of 18-24. Phase 3 was more preva-
lent in the higher age ranges encompassing 45 to greater than 65
years. The age range of 25-64 appeared to be a transition cate-
gory primarily expressing Phase 2 degeneration.
5. Certain occupations expressed either a predominance of
phase 1, 2, or 3. A group of six professions, expressed a similar
pattern of predominantly phase 2 followed by phase 1, with
phase 3 being least represented. Since age was correlated with
occupation, it is likely that the two factors expressed a combined
effect. It also appears that certain occupations can alter the pre-
dicted age - degeneration relationship.
6. Further study is required to verify these findings with an
emphasis placed on a larger study population, adherence to pro-
tocols which reduce bias, and characterization of non-respon-
dents as to differences and similarities to the study population.
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8 JOURNAL OF VERTEBRAL SUBLUXATION RESEARCH, VOL. 1, NO. 2 Characterization of Spinal Curve and Degeneration