Relation of Craniovertebral Angle With Lumbar Proprioception and Trunk Muscles Strength in Patients With Cervical Radiculopathy

Cervical radiculopathy is a major disabling condition characterized by neck pain radiating to one or both of the upper extremities . Epidemiological data suggest that CR affects approximately 83 per 100,000 individuals annually, with peak incidence occurring between ages 40 and 50 years and a lifetime prevalence of 3.5% in the general population .

Cervical radiculopathy is a common neurological condition caused by nerve root compression. Cervical radiculopathy is frequently associated with neck pain and includes tingling, numbness, or discomfort in the arm, upper back, and upper chest with or without an associated headache. Frequent headaches, scapular pain, and sensory, motor and reflex dysfunction in the upper extremities are often associated with cervical radiculopathy. These symptoms can be extended to the neck muscles, zygapophyseal joints, intervertebral discs, nerve roots, or trunk. In addition, higher levels of self-reported disability are reported among patients with neck pain and cervical radiculopathy .

The underlying cervical spinal pathologies, including disc herniation, osteophyte formation, and spinal canal stenosis, are widely recognized as common precipitating factors for nerve root compression or inflammation in CR . Approximately 70-75% of CR cases co-occur with degenerative changes, while 20-25% are attributed to intervertebral disc herniation. Repetitive overloads and micro-injuries lead to spinal canal narrowing and disc degeneration via the hypertrophy of the spinal joints and the encroachment of surrounding structures. This degeneration promotes osteophyte formation, elevated levels of local prostaglandins causing inflammation near the dorsal root ganglion .

According to the latest Global Burden of Disease data, neck pain is the fourth leading cause of years lived with disability, following only back pain, major depressive disorder, and arthralgias .Over the past ten years, there has been an increase of 19% in both the prevalence of cervical spine pain and the number of years people have been disabled globally.

Forward head posture (FHP) is a poor habitual neck posture resulting from the prolonged inherence of a static awkward position .It is associated with muscle imbalance and joint decentration, particularly at the atlanto-occipital joint, C4-C5 segment, glenohumeral joint, cervicothoracic joint, and T4-T5 segment . FHP has been viewed as a cervical sagittal imbalance and is defined as an increase in C2-C7 sagittal vertical alignment (SVA). Lately, cervical sagittal vertical alignment has been found to be the most relevant parameter of cervical sagittal balance in distinguishing symptomatic subjects from asymptomatic subjects .