Cervical Subcutaneous Fat Index and Lordosis in Intervertebral Disc Degeneration: Is There a Link?

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Yusuf Can¹, Hatice Betigül Meral² This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7947823/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : This retrospective study aimed to investigate the relationship between cervical intervertebral disc degeneration (IVDD), cervical lordosis angle (CL), and the posterior Subcutaneous Fat Index (SFI) in adults presenting with neck pain. Methods : A total of 250 patients aged 18–65 years who underwent cervical MRI between 2023 and 2025 were evaluated. Intervertebral discs from C2–T1 were graded using the Pfirrmann classification on T2-weighted midsagittal images. The CL was measured by the posterior tangent method from C2–C7. Posterior SFI was calculated as the ratio of subcutaneous fat thickness to total posterior soft tissue thickness (fat + muscle). Patients were classified into loss of lordosis and normal lordosis groups. Independent samples t-test, Spearman’s correlation, and multiple regression analyses were applied. Results : The mean age of the cohort was 39.15±12.79 years, with 58% females and 42% males. The mean BMI was 22.45±1.48 kg/m² and the mean CL angle was −10.08±11.33°. No significant differences in segmental SFI values were observed between loss of lordosis (n=96) and normal lordosis (n=154) groups (all p>0.05). Pfirrmann grades were also similar across most levels, except for C6–7, where significantly greater degeneration was detected in the normal lordosis group (p=0.039). No significant correlations were found between CL and either SFI or Pfirrmann grades. In regression analysis, age, BMI, SFI, and Pfirrmann grade were not independent predictors of CL. Conclusion : Posterior cervical SFI and lordosis angle were not generally associated with IVDD in this cohort. The significant finding at the C6–7 level should be considered an isolated result. These data support the multifactorial nature of IVDD and highlight the need for larger, prospective studies. Health sciences/Anatomy Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Cervical vertebrae Disc degeneration Magnetic resonance imaging Obesity Pfirrmann grading Subcutaneous fat index Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Cervical intervertebral disc degeneration (IVDD) is a chronic, multifactorial musculoskeletal disorder characterized by the disruption of the mechanical stability of the disc. As one of the leading causes of neck and low back pain ( 1 ). IVDD represents a significant clinical and societal problem that adversely affects quality of life. Degenerative changes in the cervical and lumbar spine regions are associated with increased medical consultations, hospitalizations, and surgical interventions, thereby imposing a substantial economic burden on both individuals and healthcare systems ( 2 ). Despite its high prevalence, the etiology, progression, and prevention of IVDD remain inadequately understood. Several risk factors contributing to the development of IVDD have been identified in the literature, including advanced age, female sex, smoking, trauma, and obesity ( 3 – 10 ). Among these, obesity plays a crucial role by increasing the mechanical load on the spine, thereby accelerating degenerative processes ( 11 ). However, the commonly used body mass index (BMI), which reflects overall body fat, is insufficient for evaluating localized fat distribution. Recent studies have emphasized that localized fat accumulation—particularly subcutaneous fat tissue thickness (SFTT) in the cervical region—may be a more relevant indicator for assessing its impact on disc degeneration ( 12 – 13 ). In this context, the Subcutaneous Fat Index (SFI) was developed ( 14 , 15 ). This index is calculated as the ratio of subcutaneous fat thickness to the combined thickness of subcutaneous fat and muscle at the same anatomical level, typically measured from the skin surface to the vertebral plate. By accounting for both fat and muscle tissues, the SFI provides a more sensitive parameter for evaluating regional fat–muscle balance. Although multiple studies in the lumbar region have demonstrated a significant association between SFI and disc degeneration, the number of similar studies in the cervical spine remains limited. Another structural parameter frequently evaluated in relation to IVDD is the cervical lordosis angle (CL). The reduction or loss of the natural cervical curvature alters the biomechanical load distribution across intervertebral discs, potentially accelerating degenerative changes due to increased mechanical stress on cervical structures(16–18). Recent studies have reported that decreased cervical lordosis is associated with higher pain scores and more advanced disc degeneration. Although a limited number of studies have independently examined the relationship between cervical lordosis and disc degeneration, and between SFI and disc degeneration, the association between cervical lordosis angle and regional fat–muscle composition (SFI), as well as their combined effect on cervical IVDD, has not been sufficiently investigated in the current literature. This study aims to investigate the relationship between cervical intervertebral disc degeneration (assessed using the Pfirrmann grading system), CL, and the posterior SFI in individuals presenting with neck pain. The findings are expected to contribute to the early identification of cervical degeneration and the development of targeted rehabilitation strategies. MATERIALS AND METHODS Patient Population This retrospective study included patients aged between 18 and 65 years who presented to our hospital’s outpatient clinic with complaints of neck pain and underwent cervical magnetic resonance imaging (MRI) between 2023 and 2025. Patients with a history of malignancy, spinal trauma, cervical surgery, or with congenital anomalies, scoliosis, kyphosis, spondylolysis, spondylolisthesis, as well as patients with spinal infections or MRI artifacts (e.g., motion artifacts) that prevented proper image evaluation, were excluded. The study was approved by the local Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki. MRI Acquisition Protocol MRI Acquisition Protocol MRI was performed using a 1.5 Tesla Signa HDxt system (GE Healthcare). The standard imaging protocol included sagittal and axial T1-weighted and T2-weighted fast spin-echo sequences. All scans were acquired with patients in the supine position, without the use of contrast media. All MRI images were assessed by the study’s author, YC, using the hospital’s Picture Archiving and Communication System (PACS) on high-resolution diagnostic monitors. Measurement of Cervical Lordosis Angle The cervical lordosis angle was measured using the posterior tangent method, which calculates the angle between lines drawn along the posterior borders of the C2 and C7 vertebral bodies ( 19 ). This method reflects the total cervical curvature. All measurements were performed on T2-weighted sagittal MRI slices that passed through the midline of the cervical spine (Fig. 1 ). Cervical alignment was classified according to the criteria defined by Grob et al ( 20 ). Specifically, loss of cervical lordosis (or straight cervical spine) was defined as an angle between + 4° and − 4°, normal lordosis as an angle greater than + 4°, and kyphosis as an angle less than − 4°. In the present study, only patients with lordotic or straight cervical alignment were included, and participants were grouped as either "loss of lordosis" or "normal lordosis" for subgroup comparisons. Evaluation of Cervical Disc Degeneration Intervertebral disc degeneration was assessed at all levels from C2–C3 to C7–T1 using mid-sagittal T2-weighted images. The severity of degeneration was evaluated based on the Pfirrmann grading system ( 21 ). This classification considers four main features: the distinction between the nucleus pulposus and annulus fibrosus, the structure of the disc, signal intensity, and disc height. Each cervical level was graded individually on a five-point scale, where Grade 1 indicates a healthy, non-degenerated disc, and Grades 2 to 5 represent increasing severity of degeneration, with Grade 5 reflecting severe disc changes. Measurement of Cervical Subcutaneous Fat Index Subcutaneous fat and paravertebral muscle thicknesses were measured at each cervical disc level (C2/3, C3/4, C4/5, C5/6, C6/7, and C7/T1) using median sagittal T2-weighted MRI images. Measurements were obtained from the midline sagittal slices to assess the distance between the skin surface and the underlying anatomical structures. Subcutaneous fat thickness was defined as the perpendicular distance from the skin surface to the fascia overlying the cervical musculature, while muscle thickness was measured from the posterior aspect of the vertebral body to the muscle–fat interface (Fig. 2 ). The SFI was calculated at each level as described in the literature, by dividing the subcutaneous fat thickness by the total posterior soft tissue thickness (i.e., fat + muscle), providing a quantitative assessment of fat distribution in the posterior cervical region ( 22 ). Statistical Analysis All statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) version 25.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables were presented as frequencies and percentages. The Shapiro-Wilk test was used to evaluate the normality of distribution for continuous variables. For group comparisons, independent samples t-tests were applied to compare segmental SFI values and Pfirrmann grades between individuals with and without cervical lordosis. The relationships between cervical lordosis angle and segmental SFI values or Pfirrmann grades were analyzed using Spearman’s rank correlation coefficient due to the non-parametric nature of the data. To identify independent predictors of cervical lordosis angle, a multiple linear regression analysis was conducted, including age, BMI, C5–6 SFI, and C5–6 Pfirrmann grade as covariates. Additionally, a binary logistic regression analysis was performed to assess the influence of selected variables on the likelihood of advanced Pfirrmann grade degeneration. A p-value of < 0.05 was considered statistically significant in all analyses. RESULTS A total of 250 patients were included in the study, with a mean age of 39.15 ± 12.79 years. Of the participants, 58% were female and 42% male. The average BMI was 22.45 ± 1.48 kg/m², and the mean cervical lordosis angle was − 10.08 ± 11.33°, indicating a general trend toward reduced lordosis (Table 1 ). Table 1 General Demographic and Clinical Characteristics of the Study Population Parameter Patients Age (years) 39,15 ± 12,79 Gender n (%) Female (58) Male (42) BMI (kg/m²) 22,45 ± 1,48 Cervical Lordosis (°) -10,08 ± 11,33 When comparing patients with loss of cervical lordosis (n = 96) and those with normal cervical lordosis (n = 154), no statistically significant differences were found in segmental SFI values across all cervical levels (C2–3 to C7–T1) (p > 0.05). Similarly, segmental Pfirrmann grades showed no significant difference between groups, except at the C6–7 level, where higher degeneration was observed in the normal lordosis group (p = 0.039) (Table 2 ). Table 2 Comparison of Segmental SFI and Pfirrmann Grades Based on Cervical Lordosis Variable Loss of Lordosis (n = 96) Normal Lordosis (n = 154) p-value C2–3 SFI (%) 24,97 ± 6,73 25,53 ± 6,33 0,518 C3–4 SFI (%) 22,66 ± 6,42 23,88 ± 6,22 0,140 C4–5 SFI (%) 25,99 ± 10,93 24,88 ± 8,11 0,391 C5–6 SFI (%) 32,72 ± 10,24 32,03 ± 10,69 0,612 C6–7 SFI (%) 37,64 ± 9,77 38,16 ± 9,15 0,670 C7-T1 SFI (%) 37,95 ± 10,06 37,03 ± 9,71 0,476 Pg/C2–3 2,7 ± 0,78 2,73 ± 0,76 0,781 Pg/C3–4 2,8 ± 0,8 2,89 ± 0,77 0,396 Pg/C4–5 2,05 ± 0,32 2 ± 0 0,112 Pg/C5–6 2,81 ± 0,88 3,03 ± 1,04 0,076 Pg/C6–7 2,5 ± 0,87 2,76 ± 1,1 0,039 Pg/C7-T1 2,31 ± 0,54 2,43 ± 0,69 0,144 Correlation analyses revealed no significant association between cervical lordosis (CL) angle and segmental SFI or Pfirrmann grades at any level. Although weak negative correlations were noted at the C4–5 and C7–T1 levels, they did not reach statistical significance (Table 3 ). Table 3 Correlation Between Cervical Lordosis (CL) Angle and Segmental SFI & Pfirrmann Grades Level CL vs. SFI (r / p) CL vs. Pfirrmann Grades (r / p) C2–3 0,037 / 0,563 -0,030 / 0,639 C3–4 0,049 / 0,439 0,012 / 0,844 C4–5 -0,107 / 0,092 -0,116 / 0,067 C5–6 -0,051 / 0,421 0,020 / 0,752 C6–7 0,014 / 0,828 0,048 / 0,446 C7-T1 -0,105 / 0,097 0,016 / 0,798 Regression Analysis of Factors Influencing Cervical Lordosis: In the multiple linear regression model evaluating factors potentially associated with cervical lordosis, none of the variables reached statistical significance, although age showed a borderline association (β = −0.171, p = 0.054) (Table 4 ). C5–6 SFI and Pfirrmann grade were not independently predictive of cervical lordosis angle. Table 4 Multiple Linear Regression Analysis of Factors Associated with Cervical Lordosis (CL) Angle Independent Variable β (Beta Coefficient) Standard Error (SE) p-value Age (years) -0,171 11,179 0,054 BMI (kg/m²) -0,077 0,078 0,231 C5–6 SFI (%) -0,029 0,485 0,651 C5–6 Pfirrmann Grade 0,142 0,070 0,108 A detailed analysis of subcutaneous fat thickness at the C5–C6 level, stratified by Pfirrmann grade, revealed a trend toward increased fat thickness with advancing disc degeneration grades. Although variability was noted, a gradual increase in median values was observed, as shown in the boxplot (Fig. 3 ). DISCUSSION This study aimed to evaluate the relationship between cervical IVDD, cervical sagittal alignment (lordosis angle), and the posterior SFI in adults presenting with neck pain. Our results demonstrated that higher posterior SFI values were associated with increased severity of disc degeneration, with a statistically significant correlation at the C6–7 level. In contrast, no consistent association was found between cervical lordosis angle and either segmental SFI values or Pfirrmann grades across cervical levels. The association between localized fat accumulation and disc degeneration is increasingly recognized in recent literature. Obesity is a well-established risk factor for spinal degeneration; however, the use of BMI as a proxy for fat distribution is limited, as it does not capture regional fat accumulation that may impose mechanical stress on specific spinal segments. In our study, BMI was not significantly associated with IVDD, which aligns with previous reports indicating that general adiposity may not fully explain degenerative changes in the spine. To address this, we used the SFI, a ratio-based measure that reflects the proportion of subcutaneous fat relative to total soft tissue (fat + muscle). This provides a more accurate representation of local fat–muscle composition. Our findings demonstrated a positive trend between higher SFI values and disc degeneration severity, particularly at lower cervical segments (C5–T1), where mechanical loads tend to concentrate. Although the difference in SFI across Pfirrmann grades at C5–C6 was not statistically tested, visual inspection of the boxplot (Fig. 3 ) revealed a gradual increase in fat thickness with worsening degeneration, supporting this biomechanical interpretation. The statistically significant difference at the C6–7 level strengthens this association. This segment often serves as a biomechanical transition zone between the mobile cervical and more rigid thoracic spine, making it more vulnerable to cumulative stress. The presence of greater fat accumulation at this level may exacerbate compressive or inflammatory loads on intervertebral discs, thereby accelerating degeneration. Our findings are consistent with previous studies highlighting the role of regional subcutaneous fat tissue in cervical disc degeneration. In a study by Yüksel et al. involving 300 women aged 30–40 years, posterior cervical subcutaneous fat thickness measured at the C4–C5 level was significantly higher in patients with IVDD compared to those without degeneration, and a positive correlation was reported between fat thickness and degeneration severity [23]. However, that study utilized a single linear fat thickness measurement and did not consider underlying muscle tissue, which limits its ability to capture regional fat–muscle balance. By contrast, our use of the SFI, which calculates the fat-to-total soft tissue ratio, allows for a more nuanced assessment of localized adiposity and its potential mechanical effects on spinal structures. Further supporting this association, Emir et al. evaluated 245 Turkish women aged 40–50 and found that SFTT at multiple cervical levels, especially at C7, was significantly associated with both the presence and severity of disc degeneration. ROC analysis identified the C7 level as having the highest predictive accuracy, with an optimal cutoff value of 22.57 mm, yielding 79.19% sensitivity and 63.89% specificity for identifying IVDD [24]. Notably, the authors proposed SFTT at the C7 level as a non-invasive biomarker for cervical disc pathology. Although our study did not perform ROC analysis, we also observed a marked increase in SFI values at the C7–T1 level, and statistically significant differences in degeneration at C6–7, supporting the notion that lower cervical segments are more vulnerable to fat-related mechanical or inflammatory stress. Together, these studies suggest that posterior cervical subcutaneous fat accumulation, particularly at C6–C7 and C7–T1 levels, may serve not only as a marker of degeneration but also as a modifying factor in its progression. Importantly, our use of SFI provides added value over linear thickness measurements by accounting for the relative muscle content, offering a physiologically meaningful index that may be more reflective of biomechanical imbalance contributing to disc pathology. Additionally, Wang et al. demonstrated that SFI, as a localized marker of adiposity, better reflects spinal stress than BMI, which was not significantly associated with IVDD severity [25]. In our study, we likewise observed no relationship between BMI and degeneration, while SFI was closely linked to disc pathology. With regard to spinal alignment, our findings partially align with the study by Lee et al., who showed that a reduced C2–C7 angle correlated with increased disc degeneration based on MRI grading [26]. In our cohort, however, cervical lordosis did not consistently associate with either SFI or IVDD severity, with the exception of a significant correlation at the C6–7 level. This suggests that sagittal alignment and adiposity may influence disc degeneration through distinct mechanisms. This study has several limitations. First, its cross-sectional design does not allow causal inference. Second, the study population consisted exclusively of middle-aged Turkish women, which limits the generalizability of the findings to other demographics. Third, while SFI is an improvement over linear fat thickness or BMI, it does not account for visceral fat or overall body composition. Finally, confounding variables such as physical activity, occupational loading, smoking status, or hormonal influences were not assessed. The results of this study suggest that increased posterior cervical subcutaneous fat, particularly at the C7–T1 level, is significantly associated with greater cervical disc degeneration severity. Cervical lordosis angle was not consistently correlated with either IVDD or SFI values. Segmental subcutaneous fat accumulation may contribute to the progression of disc degeneration independently of sagittal cervical alignment. Further longitudinal studies including broader populations and functional outcomes are warranted. Abbreviations IVDD cervical intervertebral disc degeneration CL cervical lordosis angle SFI Subcutaneous Fat Index BMI body mass index SFTT subcutaneous fat tissue thickness MRI magnetic resonance imaging Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Istanbul Medipol University (IRB number: E-10840098-202.3.02-3814 20/06/2025). Written consent was obtained from all patients who participated in this study. All patients were informed about the purpose of the study in accordance with the principles of the Declaration of Helsinki, and written/oral consent was obtained for their participation. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Author details ¹Department of Radiology, Istanbul Medipol University, Istanbul, Turkey ² Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey Clinical trial number not applicable Corresponding Author Yusuf CAN; [email protected] Funding No funding was obtained for this study. Author Contribution YC checked all MR images and measured all metrics. YC drafted the manuscript. HBM performed the statistical analysis. YC and HBM critically revised the manuscript. YC and HBM designed the study . All authors read and approved the final manuscript. Acknowledgments There is no acknowledgments Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Sampara, P. et al. 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06:30:39","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86990,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7947823/v1/0a661eaca3286da73cdc59aa.html"},{"id":94640189,"identity":"8e4cadf8-894a-4791-8d9c-fd62ad9f6e54","added_by":"auto","created_at":"2025-10-29 07:48:40","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":159760,"visible":true,"origin":"","legend":"\u003cp\u003eAksial T2 weighted image shows midsagittal line\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7947823/v1/f45251aab1489965f4dc9cc1.jpeg"},{"id":94640592,"identity":"a0f4dcb5-49e7-47bd-99b3-a41db7bfdc1e","added_by":"auto","created_at":"2025-10-29 07:49:53","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163555,"visible":true,"origin":"","legend":"\u003cp\u003eOn sagittal T2-weighted images, the red line indicates muscle thickness, whereas the yellow line represents subcutaneous adipose tissue thickness.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7947823/v1/1d5feb19498f9a75cc6ba8fe.jpeg"},{"id":94632791,"identity":"2ae25f9e-2fbd-41c8-9e6a-7bddb2be56c9","added_by":"auto","created_at":"2025-10-29 06:30:39","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":177278,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot showing the distribution of subcutaneous fat thickness at the C5–C6 cervical disc level according to \u003cstrong\u003ePfirrmann grades\u003c/strong\u003e of disc degeneration.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7947823/v1/871018d0a518dd2f2c92e41f.jpeg"},{"id":94826019,"identity":"9eaa99a0-3da4-42c5-8491-1bfd18f43b29","added_by":"auto","created_at":"2025-10-31 06:50:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1181663,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7947823/v1/ea2b093a-43dc-4096-9582-90590ecc1703.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCervical Subcutaneous Fat Index and Lordosis in Intervertebral Disc Degeneration: Is There a Link?\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCervical intervertebral disc degeneration (IVDD) is a chronic, multifactorial musculoskeletal disorder characterized by the disruption of the mechanical stability of the disc. As one of the leading causes of neck and low back pain (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). IVDD represents a significant clinical and societal problem that adversely affects quality of life. Degenerative changes in the cervical and lumbar spine regions are associated with increased medical consultations, hospitalizations, and surgical interventions, thereby imposing a substantial economic burden on both individuals and healthcare systems (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite its high prevalence, the etiology, progression, and prevention of IVDD remain inadequately understood.\u003c/p\u003e\u003cp\u003eSeveral risk factors contributing to the development of IVDD have been identified in the literature, including advanced age, female sex, smoking, trauma, and obesity (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Among these, obesity plays a crucial role by increasing the mechanical load on the spine, thereby accelerating degenerative processes (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the commonly used body mass index (BMI), which reflects overall body fat, is insufficient for evaluating localized fat distribution. Recent studies have emphasized that localized fat accumulation\u0026mdash;particularly subcutaneous fat tissue thickness (SFTT) in the cervical region\u0026mdash;may be a more relevant indicator for assessing its impact on disc degeneration (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this context, the Subcutaneous Fat Index (SFI) was developed (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This index is calculated as the ratio of subcutaneous fat thickness to the combined thickness of subcutaneous fat and muscle at the same anatomical level, typically measured from the skin surface to the vertebral plate. By accounting for both fat and muscle tissues, the SFI provides a more sensitive parameter for evaluating regional fat\u0026ndash;muscle balance. Although multiple studies in the lumbar region have demonstrated a significant association between SFI and disc degeneration, the number of similar studies in the cervical spine remains limited.\u003c/p\u003e\u003cp\u003eAnother structural parameter frequently evaluated in relation to IVDD is the cervical lordosis angle (CL). The reduction or loss of the natural cervical curvature alters the biomechanical load distribution across intervertebral discs, potentially accelerating degenerative changes due to increased mechanical stress on cervical structures(16\u0026ndash;18). Recent studies have reported that decreased cervical lordosis is associated with higher pain scores and more advanced disc degeneration. Although a limited number of studies have independently examined the relationship between cervical lordosis and disc degeneration, and between SFI and disc degeneration, the association between cervical lordosis angle and regional fat\u0026ndash;muscle composition (SFI), as well as their combined effect on cervical IVDD, has not been sufficiently investigated in the current literature.\u003c/p\u003e\u003cp\u003eThis study aims to investigate the relationship between cervical intervertebral disc degeneration (assessed using the Pfirrmann grading system), CL, and the posterior SFI in individuals presenting with neck pain. The findings are expected to contribute to the early identification of cervical degeneration and the development of targeted rehabilitation strategies.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Population\u003c/h2\u003e\u003cp\u003eThis retrospective study included patients aged between 18 and 65 years who presented to our hospital\u0026rsquo;s outpatient clinic with complaints of neck pain and underwent cervical magnetic resonance imaging (MRI) between 2023 and 2025.\u003c/p\u003e\u003cp\u003ePatients with a history of malignancy, spinal trauma, cervical surgery, or with congenital anomalies, scoliosis, kyphosis, spondylolysis, spondylolisthesis, as well as patients with spinal infections or MRI artifacts (e.g., motion artifacts) that prevented proper image evaluation, were excluded.\u003c/p\u003e\u003cp\u003e The study was approved by the local Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMRI Acquisition Protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eMRI Acquisition Protocol\u003c/div\u003e\u003cp\u003eMRI was performed using a 1.5 Tesla Signa HDxt system (GE Healthcare). The standard imaging protocol included sagittal and axial T1-weighted and T2-weighted fast spin-echo sequences. All scans were acquired with patients in the supine position, without the use of contrast media. All MRI images were assessed by the study\u0026rsquo;s author, YC, using the hospital\u0026rsquo;s Picture Archiving and Communication System (PACS) on high-resolution diagnostic monitors.\u003c/p\u003e\n\u003ch3\u003eMeasurement of Cervical Lordosis Angle\u003c/h3\u003e\n\u003cp\u003eThe cervical lordosis angle was measured using the posterior tangent method, which calculates the angle between lines drawn along the posterior borders of the C2 and C7 vertebral bodies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This method reflects the total cervical curvature. All measurements were performed on T2-weighted sagittal MRI slices that passed through the midline of the cervical spine (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCervical alignment was classified according to the criteria defined by Grob et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Specifically, loss of cervical lordosis (or straight cervical spine) was defined as an angle between +\u0026thinsp;4\u0026deg; and \u0026minus;\u0026thinsp;4\u0026deg;, normal lordosis as an angle greater than +\u0026thinsp;4\u0026deg;, and kyphosis as an angle less than \u0026minus;\u0026thinsp;4\u0026deg;. In the present study, only patients with lordotic or straight cervical alignment were included, and participants were grouped as either \"loss of lordosis\" or \"normal lordosis\" for subgroup comparisons.\u003c/p\u003e\n\u003ch3\u003eEvaluation of Cervical Disc Degeneration\u003c/h3\u003e\n\u003cp\u003eIntervertebral disc degeneration was assessed at all levels from C2\u0026ndash;C3 to C7\u0026ndash;T1 using mid-sagittal T2-weighted images. The severity of degeneration was evaluated based on the Pfirrmann grading system (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This classification considers four main features: the distinction between the nucleus pulposus and annulus fibrosus, the structure of the disc, signal intensity, and disc height. Each cervical level was graded individually on a five-point scale, where Grade 1 indicates a healthy, non-degenerated disc, and Grades 2 to 5 represent increasing severity of degeneration, with Grade 5 reflecting severe disc changes.\u003c/p\u003e\n\u003ch3\u003eMeasurement of Cervical Subcutaneous Fat Index\u003c/h3\u003e\n\u003cp\u003eSubcutaneous fat and paravertebral muscle thicknesses were measured at each cervical disc level (C2/3, C3/4, C4/5, C5/6, C6/7, and C7/T1) using median sagittal T2-weighted MRI images. Measurements were obtained from the midline sagittal slices to assess the distance between the skin surface and the underlying anatomical structures. Subcutaneous fat thickness was defined as the perpendicular distance from the skin surface to the fascia overlying the cervical musculature, while muscle thickness was measured from the posterior aspect of the vertebral body to the muscle\u0026ndash;fat interface (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe SFI was calculated at each level as described in the literature, by dividing the subcutaneous fat thickness by the total posterior soft tissue thickness (i.e., fat\u0026thinsp;+\u0026thinsp;muscle), providing a quantitative assessment of fat distribution in the posterior cervical region (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) version 25.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and categorical variables were presented as frequencies and percentages. The Shapiro-Wilk test was used to evaluate the normality of distribution for continuous variables. For group comparisons, independent samples t-tests were applied to compare segmental SFI values and Pfirrmann grades between individuals with and without cervical lordosis. The relationships between cervical lordosis angle and segmental SFI values or Pfirrmann grades were analyzed using Spearman\u0026rsquo;s rank correlation coefficient due to the non-parametric nature of the data. To identify independent predictors of cervical lordosis angle, a multiple linear regression analysis was conducted, including age, BMI, C5\u0026ndash;6 SFI, and C5\u0026ndash;6 Pfirrmann grade as covariates. Additionally, a binary logistic regression analysis was performed to assess the influence of selected variables on the likelihood of advanced Pfirrmann grade degeneration.\u003c/p\u003e\u003cp\u003eA p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant in all analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 250 patients were included in the study, with a mean age of 39.15\u0026thinsp;\u0026plusmn;\u0026thinsp;12.79 years. Of the participants, 58% were female and 42% male. The average BMI was 22.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48 kg/m\u0026sup2;, and the mean cervical lordosis angle was \u0026minus;\u0026thinsp;10.08\u0026thinsp;\u0026plusmn;\u0026thinsp;11.33\u0026deg;, indicating a general trend toward reduced lordosis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral Demographic and Clinical Characteristics of the Study Population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39,15\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;12,79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGender n (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22,45\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1,48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCervical Lordosis (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-10,08\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;11,33\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen comparing patients with loss of cervical lordosis (n\u0026thinsp;=\u0026thinsp;96) and those with normal cervical lordosis (n\u0026thinsp;=\u0026thinsp;154), no statistically significant differences were found in segmental SFI values across all cervical levels (C2\u0026ndash;3 to C7\u0026ndash;T1) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, segmental Pfirrmann grades showed no significant difference between groups, except at the C6\u0026ndash;7 level, where higher degeneration was observed in the normal lordosis group (p\u0026thinsp;=\u0026thinsp;0.039) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Segmental SFI and Pfirrmann Grades Based on Cervical Lordosis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLoss of Lordosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormal Lordosis (n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC2\u0026ndash;3 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e24,97\u0026thinsp;\u0026plusmn;\u0026thinsp;6,73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25,53\u0026thinsp;\u0026plusmn;\u0026thinsp;6,33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,518\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC3\u0026ndash;4 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e22,66\u0026thinsp;\u0026plusmn;\u0026thinsp;6,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e23,88\u0026thinsp;\u0026plusmn;\u0026thinsp;6,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC4\u0026ndash;5 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e25,99\u0026thinsp;\u0026plusmn;\u0026thinsp;10,93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e24,88\u0026thinsp;\u0026plusmn;\u0026thinsp;8,11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC5\u0026ndash;6 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e32,72\u0026thinsp;\u0026plusmn;\u0026thinsp;10,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e32,03\u0026thinsp;\u0026plusmn;\u0026thinsp;10,69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,612\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC6\u0026ndash;7 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e37,64\u0026thinsp;\u0026plusmn;\u0026thinsp;9,77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e38,16\u0026thinsp;\u0026plusmn;\u0026thinsp;9,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,670\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC7-T1 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e37,95\u0026thinsp;\u0026plusmn;\u0026thinsp;10,06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e37,03\u0026thinsp;\u0026plusmn;\u0026thinsp;9,71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C2\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,7\u0026thinsp;\u0026plusmn;\u0026thinsp;0,78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2,73\u0026thinsp;\u0026plusmn;\u0026thinsp;0,76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,781\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C3\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,8\u0026thinsp;\u0026plusmn;\u0026thinsp;0,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2,89\u0026thinsp;\u0026plusmn;\u0026thinsp;0,77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,396\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C4\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,05\u0026thinsp;\u0026plusmn;\u0026thinsp;0,32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C5\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,81\u0026thinsp;\u0026plusmn;\u0026thinsp;0,88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3,03\u0026thinsp;\u0026plusmn;\u0026thinsp;1,04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C6\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,5\u0026thinsp;\u0026plusmn;\u0026thinsp;0,87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2,76\u0026thinsp;\u0026plusmn;\u0026thinsp;1,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,039\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePg/C7-T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2,31\u0026thinsp;\u0026plusmn;\u0026thinsp;0,54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2,43\u0026thinsp;\u0026plusmn;\u0026thinsp;0,69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCorrelation analyses revealed no significant association between cervical lordosis (CL) angle and segmental SFI or Pfirrmann grades at any level. Although weak negative correlations were noted at the C4\u0026ndash;5 and C7\u0026ndash;T1 levels, they did not reach statistical significance (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation Between Cervical Lordosis (CL) Angle and Segmental SFI \u0026amp; Pfirrmann Grades\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCL vs. SFI \u003cem\u003e(r / p)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCL vs. Pfirrmann Grades \u003cem\u003e(r / p)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC2\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,037 / 0,563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,030 / 0,639\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC3\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,049 / 0,439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,012 / 0,844\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC4\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,107 / 0,092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,116 / 0,067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC5\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,051 / 0,421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,020 / 0,752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC6\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,014 / 0,828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,048 / 0,446\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC7-T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,105 / 0,097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,016 / 0,798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegression Analysis of Factors Influencing Cervical Lordosis:\u003c/p\u003e\u003cp\u003eIn the multiple linear regression model evaluating factors potentially associated with cervical lordosis, none of the variables reached statistical significance, although age showed a borderline association (β = \u0026minus;0.171, p\u0026thinsp;=\u0026thinsp;0.054) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). C5\u0026ndash;6 SFI and Pfirrmann grade were not independently predictive of cervical lordosis angle.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple Linear Regression Analysis of Factors Associated with Cervical Lordosis (CL) Angle\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndependent Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ (Beta Coefficient)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error (SE)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11,179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC5\u0026ndash;6 SFI (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,651\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC5\u0026ndash;6 Pfirrmann Grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA detailed analysis of subcutaneous fat thickness at the C5\u0026ndash;C6 level, stratified by Pfirrmann grade, revealed a trend toward increased fat thickness with advancing disc degeneration grades. Although variability was noted, a gradual increase in median values was observed, as shown in the boxplot (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to evaluate the relationship between cervical IVDD, cervical sagittal alignment (lordosis angle), and the posterior SFI in adults presenting with neck pain. Our results demonstrated that higher posterior SFI values were associated with increased severity of disc degeneration, with a statistically significant correlation at the C6\u0026ndash;7 level. In contrast, no consistent association was found between cervical lordosis angle and either segmental SFI values or Pfirrmann grades across cervical levels.\u003c/p\u003e\u003cp\u003eThe association between localized fat accumulation and disc degeneration is increasingly recognized in recent literature. Obesity is a well-established risk factor for spinal degeneration; however, the use of BMI as a proxy for fat distribution is limited, as it does not capture regional fat accumulation that may impose mechanical stress on specific spinal segments. In our study, BMI was not significantly associated with IVDD, which aligns with previous reports indicating that general adiposity may not fully explain degenerative changes in the spine.\u003c/p\u003e\u003cp\u003eTo address this, we used the SFI, a ratio-based measure that reflects the proportion of subcutaneous fat relative to total soft tissue (fat\u0026thinsp;+\u0026thinsp;muscle). This provides a more accurate representation of local fat\u0026ndash;muscle composition. Our findings demonstrated a positive trend between higher SFI values and disc degeneration severity, particularly at lower cervical segments (C5\u0026ndash;T1), where mechanical loads tend to concentrate. Although the difference in SFI across Pfirrmann grades at C5\u0026ndash;C6 was not statistically tested, visual inspection of the boxplot (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed a gradual increase in fat thickness with worsening degeneration, supporting this biomechanical interpretation.\u003c/p\u003e\u003cp\u003eThe statistically significant difference at the C6\u0026ndash;7 level strengthens this association. This segment often serves as a biomechanical transition zone between the mobile cervical and more rigid thoracic spine, making it more vulnerable to cumulative stress. The presence of greater fat accumulation at this level may exacerbate compressive or inflammatory loads on intervertebral discs, thereby accelerating degeneration.\u003c/p\u003e\u003cp\u003eOur findings are consistent with previous studies highlighting the role of regional subcutaneous fat tissue in cervical disc degeneration. In a study by Y\u0026uuml;ksel et al. involving 300 women aged 30\u0026ndash;40 years, posterior cervical subcutaneous fat thickness measured at the C4\u0026ndash;C5 level was significantly higher in patients with IVDD compared to those without degeneration, and a positive correlation was reported between fat thickness and degeneration severity [23]. However, that study utilized a single linear fat thickness measurement and did not consider underlying muscle tissue, which limits its ability to capture regional fat\u0026ndash;muscle balance. By contrast, our use of the SFI, which calculates the fat-to-total soft tissue ratio, allows for a more nuanced assessment of localized adiposity and its potential mechanical effects on spinal structures.\u003c/p\u003e\u003cp\u003eFurther supporting this association, Emir et al. evaluated 245 Turkish women aged 40\u0026ndash;50 and found that SFTT at multiple cervical levels, especially at C7, was significantly associated with both the presence and severity of disc degeneration. ROC analysis identified the C7 level as having the highest predictive accuracy, with an optimal cutoff value of 22.57 mm, yielding 79.19% sensitivity and 63.89% specificity for identifying IVDD [24]. Notably, the authors proposed SFTT at the C7 level as a non-invasive biomarker for cervical disc pathology. Although our study did not perform ROC analysis, we also observed a marked increase in SFI values at the C7\u0026ndash;T1 level, and statistically significant differences in degeneration at C6\u0026ndash;7, supporting the notion that lower cervical segments are more vulnerable to fat-related mechanical or inflammatory stress.\u003c/p\u003e\u003cp\u003eTogether, these studies suggest that posterior cervical subcutaneous fat accumulation, particularly at C6\u0026ndash;C7 and C7\u0026ndash;T1 levels, may serve not only as a marker of degeneration but also as a modifying factor in its progression. Importantly, our use of SFI provides added value over linear thickness measurements by accounting for the relative muscle content, offering a physiologically meaningful index that may be more reflective of biomechanical imbalance contributing to disc pathology.\u003c/p\u003e\u003cp\u003eAdditionally, Wang et al. demonstrated that SFI, as a localized marker of adiposity, better reflects spinal stress than BMI, which was not significantly associated with IVDD severity [25]. In our study, we likewise observed no relationship between BMI and degeneration, while SFI was closely linked to disc pathology.\u003c/p\u003e\u003cp\u003eWith regard to spinal alignment, our findings partially align with the study by Lee et al., who showed that a reduced C2\u0026ndash;C7 angle correlated with increased disc degeneration based on MRI grading [26]. In our cohort, however, cervical lordosis did not consistently associate with either SFI or IVDD severity, with the exception of a significant correlation at the C6\u0026ndash;7 level. This suggests that sagittal alignment and adiposity may influence disc degeneration through distinct mechanisms.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, its cross-sectional design does not allow causal inference. Second, the study population consisted exclusively of middle-aged Turkish women, which limits the generalizability of the findings to other demographics. Third, while SFI is an improvement over linear fat thickness or BMI, it does not account for visceral fat or overall body composition. Finally, confounding variables such as physical activity, occupational loading, smoking status, or hormonal influences were not assessed.\u003c/p\u003e\u003cp\u003eThe results of this study suggest that increased posterior cervical subcutaneous fat, particularly at the C7\u0026ndash;T1 level, is significantly associated with greater cervical disc degeneration severity. Cervical lordosis angle was not consistently correlated with either IVDD or SFI values. Segmental subcutaneous fat accumulation may contribute to the progression of disc degeneration independently of sagittal cervical alignment. Further longitudinal studies including broader populations and functional outcomes are warranted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIVDD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecervical intervertebral disc degeneration\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecervical lordosis angle\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSFI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSubcutaneous Fat Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSFTT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esubcutaneous fat tissue thickness\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emagnetic resonance imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Istanbul Medipol University (IRB number: E-10840098-202.3.02-3814 20/06/2025). Written consent was obtained from all patients who participated in this study. All patients were informed about the purpose of the study in accordance with the principles of the Declaration of Helsinki, and written/oral consent was obtained for their participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eAuthor details\u003c/h2\u003e\n\u003cp\u003e\u0026sup1;Department of Radiology, Istanbul Medipol University, Istanbul, Turkey\u003c/p\u003e\n\u003cp\u003e\u0026sup2; Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYusuf CAN; [email protected]\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eYC checked all MR images and measured all metrics. YC drafted the manuscript. HBM performed the statistical analysis. YC and HBM critically revised the manuscript. YC and HBM designed the study . All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThere is no acknowledgments\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSampara, P. et al. Understanding the molecular biology of intervertebral disc degeneration and potential gene therapy strategies for regeneration: a review. \u003cem\u003eGene Ther.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e (2), 67\u0026ndash;82 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKadow, T. et al. 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(Wars)\u003c/em\u003e. \u003cb\u003e16\u003c/b\u003e (1), 161\u0026ndash;168. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1515/med-2021-0219\u003c/span\u003e\u003cspan address=\"10.1515/med-2021-0219\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cervical vertebrae, Disc degeneration, Magnetic resonance imaging, Obesity, Pfirrmann grading, Subcutaneous fat index","lastPublishedDoi":"10.21203/rs.3.rs-7947823/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7947823/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This retrospective study aimed to investigate the relationship between cervical intervertebral disc degeneration (IVDD), cervical lordosis angle (CL), and the posterior Subcutaneous Fat Index (SFI) in adults presenting with neck pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A total of 250 patients aged 18–65 years who underwent cervical MRI between 2023 and 2025 were evaluated. Intervertebral discs from C2–T1 were graded using the Pfirrmann classification on T2-weighted midsagittal images. The CL was measured by the posterior tangent method from C2–C7. Posterior SFI was calculated as the ratio of subcutaneous fat thickness to total posterior soft tissue thickness (fat + muscle). Patients were classified into loss of lordosis and normal lordosis groups. Independent samples t-test, Spearman’s correlation, and multiple regression analyses were applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The mean age of the cohort was 39.15±12.79 years, with 58% females and 42% males. The mean BMI was 22.45±1.48 kg/m² and the mean CL angle was −10.08±11.33°. No significant differences in segmental SFI values were observed between loss of lordosis (n=96) and normal lordosis (n=154) groups (all p\u0026gt;0.05). Pfirrmann grades were also similar across most levels, except for C6–7, where significantly greater degeneration was detected in the normal lordosis group (p=0.039). No significant correlations were found between CL and either SFI or Pfirrmann grades. In regression analysis, age, BMI, SFI, and Pfirrmann grade were not independent predictors of CL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Posterior cervical SFI and lordosis angle were not generally associated with IVDD in this cohort. The significant finding at the C6–7 level should be considered an isolated result. These data support the multifactorial nature of IVDD and highlight the need for larger, prospective studies.\u003c/p\u003e","manuscriptTitle":"Cervical Subcutaneous Fat Index and Lordosis in Intervertebral Disc Degeneration: Is There a Link?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 06:30:35","doi":"10.21203/rs.3.rs-7947823/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19b6897d-ff96-4a63-b28d-b20e2885733c","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56986444,"name":"Health sciences/Anatomy"},{"id":56986445,"name":"Health sciences/Diseases"},{"id":56986446,"name":"Health sciences/Health care"},{"id":56986447,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-10-31T03:08:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 06:30:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7947823","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7947823","identity":"rs-7947823","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}