A comprehensive analysis of the association of psychological profiling and sagittal balance parameters with neck pain in a non-deformity cervical spondylosis population: A prospective two-centers cross-sectional study.
8 affiliations
- 1Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy. [email protected].
- 2Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy. [email protected].
- 3Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- 4Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia, Rome, Oncologia Ed Ematologia, Italy.
- 5Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
- 6Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy.
- 7Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, Rome, 00168, Italy.
- 8Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, 20089, Italy.
Abstract
Purpose to comprehensively identify determining factors of perceived neck pain in a non-deformity population, integrating psychological and sagittal balance parameters.Methods a cross-sectional study of prospectively collected data was conducted on patients admitted for cervical spondylosis at two tertiary university hospitals between April 2024 and August 2025. Eligible cases were retrieved from the PANDA Registry. Records were excluded if standing X-ray was unavailable and/or not-evaluable (e.g. shoulder prosthesis); or if the admission pathology involved the cranio-cervical junction, tumors, deformities, spinal cord disease, or infections. Preoperative data included demographic, clinical (VAS neck), psychological (SCL-27, I-TIPI, CD-RISC10), and sagittal balance variables (McGregor slope, C1-C2 lordosis, C2 slope, C2-C7 lordosis, cSVA, T1 slope, cervical mismatch). Correction for multiple comparisons was applied within pre-specified hypothesis domains.Results one-hundred-thirty records were included. Intra-rater reliability for radiographic parameters was excellent (> 0.9). After categorization of patients by neck pain severity, pairwise analysis showed that only C1-C2 lordosis remained significantly higher in patients exhibiting severe neck pain (VAS < 7 vs. VAS ≥ 7). When stratified for moderate-to-severe neck pain (VAS ≥ 4), several SCL-27 scales, namely dysthymic, vegetative, agoraphobic, sociophobic, and GSI scores, and C1C2 lordosis showed significant differences. Correlation analysis using VAS neck as the dependent variable demonstrated a significant positive correlation with SCL-27 dysthymic and vegetative scores. C1-C2 lordosis showed a significant inverse correlation with neck pain. In univariate analysis, only SCL-27 dysthymic, vegetative, and GSI scores emerged as significant univariate associations of VAS neck. After correction for multiple comparisons, the SCL-27 vegetative, dysthymic and GSI scores retained significance, whereas C1-C2 lordosis did not.Conclusion in a non-deformity population, sagittal balance parameters alone do not adequately explain patient-perceived neck pain. These findings support the preoperative use of psychological assessments, especially the SCL-27, as a useful tool in preoperative screening and individualised counselling.
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BibTeX
@article{battistelli2026comprehensive,
title = {{A comprehensive analysis of the association of psychological profiling and sagittal balance parameters with neck pain in a non-deformity cervical spondylosis population: A prospective two-centers cross-sectional study.}},
author = {Marco Battistelli and Sofia Vannuccini and Massimo Benenati and Mario Muselli and Nicola Montano and Massimiliano Visocchi and Gabriele Capo and Carlo Brembilla and Maurizio Fornari and Simona Gaudino and Francesco Doglietto and Filippo Maria Polli and Daniela Pia Rosaria Chieffo},
journal = {Neurosurgical review},
year = {2026},
month = oct,
doi = {10.1007/s10143-026-04527-z},
url = {https://europepmc.org/article/MED/42894039},
note = {CC BY},
}
RIS
TY - JOUR
TI - A comprehensive analysis of the association of psychological profiling and sagittal balance parameters with neck pain in a non-deformity cervical spondylosis population: A prospective two-centers cross-sectional study.
AU - Marco Battistelli
AU - Sofia Vannuccini
AU - Massimo Benenati
AU - Mario Muselli
AU - Nicola Montano
AU - Massimiliano Visocchi
AU - Gabriele Capo
AU - Carlo Brembilla
AU - Maurizio Fornari
AU - Simona Gaudino
AU - Francesco Doglietto
AU - Filippo Maria Polli
AU - Daniela Pia Rosaria Chieffo
PY - 2026
DA - 2026/10/19
JO - Neurosurgical review
DO - 10.1007/s10143-026-04527-z
UR - https://europepmc.org/article/MED/42894039
AB - Purpose to comprehensively identify determining factors of perceived neck pain in a non-deformity population, integrating psychological and sagittal balance parameters.Methods a cross-sectional study of prospectively collected data was conducted on patients admitted for cervical spondylosis at two tertiary university hospitals between April 2024 and August 2025. Eligible cases were retrieved from the PANDA Registry. Records were excluded if standing X-ray was unavailable and/or not-evaluable (e.g. shoulder prosthesis); or if the admission pathology involved the cranio-cervical junction, tumors, deformities, spinal cord disease, or infections. Preoperative data included demographic, clinical (VAS neck), psychological (SCL-27, I-TIPI, CD-RISC10), and sagittal balance variables (McGregor slope, C1-C2 lordosis, C2 slope, C2-C7 lordosis, cSVA, T1 slope, cervical mismatch). Correction for multiple comparisons was applied within pre-specified hypothesis domains.Results one-hundred-thirty records were included. Intra-rater reliability for radiographic parameters was excellent (> 0.9). After categorization of patients by neck pain severity, pairwise analysis showed that only C1-C2 lordosis remained significantly higher in patients exhibiting severe neck pain (VAS < 7 vs. VAS ≥ 7). When stratified for moderate-to-severe neck pain (VAS ≥ 4), several SCL-27 scales, namely dysthymic, vegetative, agoraphobic, sociophobic, and GSI scores, and C1C2 lordosis showed significant differences. Correlation analysis using VAS neck as the dependent variable demonstrated a significant positive correlation with SCL-27 dysthymic and vegetative scores. C1-C2 lordosis showed a significant inverse correlation with neck pain. In univariate analysis, only SCL-27 dysthymic, vegetative, and GSI scores emerged as significant univariate associations of VAS neck. After correction for multiple comparisons, the SCL-27 vegetative, dysthymic and GSI scores retained significance, whereas C1-C2 lordosis did not.Conclusion in a non-deformity population, sagittal balance parameters alone do not adequately explain patient-perceived neck pain. These findings support the preoperative use of psychological assessments, especially the SCL-27, as a useful tool in preoperative screening and individualised counselling.
SN - 0344-5607
SN - 1437-2320
ER -