Associations among cervical radiographic morphology, degeneration severity, and clinical presentation: a retrospective cross-sectional study of 250 outpatient examinations

Objectives To examine associations among cervical radiographic morphology, degeneration severity, demographic characteristics, primary clinical presentation, pain intensity, and neck-related patient-reported outcomes.Methods This retrospective cross-sectional review included 250 cervical radiographic examinations obtained from outpatient chiropractic teaching clinics from 10 May 2021 through 11 March 2024. Every fifth eligible examination was sampled in reverse chronological order. Demographic, clinical, and radiographic variables were abstracted from de-identified records and radiology reports. Pain scores were available for 238 examinations. Because four non-equivalent outcome instruments were used, scores were not pooled; the main patient-reported outcome analyses were restricted to the Neck Bournemouth Questionnaire (NBQ; n = 90). Spearman correlations, Kruskal-Wallis tests, chi-square tests, and multivariable logistic regression were used.Results The sample included 132 females and 118 males (mean age, 38.2 ± 16.3 years). Age was strongly associated with degeneration severity (ρ = 0.783; 95% CI, 0.725–0.829; p < 0.001). Degeneration was weakly associated with pain (ρ = 0.232; 95% CI, 0.107–0.356; p < 0.001) and NBQ score (ρ = 0.230; 95% CI, 0.017–0.436; p = 0.030). Pain differed across degeneration categories, with a small effect (H(3) = 12.76; p = 0.005; ε2 = 0.042), but not across lateral morphology categories (p = 0.672). In the adjusted model, a one-category increase in degeneration severity had a positive but imprecise association with radiculopathy (OR = 1.56; 95% CI, 0.93–2.62; p = 0.089); age, sex, and morphology variables were not independently associated with radiculopathy.Discussion/Conclusion Age was the dominant correlate of radiographic degeneration. Associations of degeneration with pain, NBQ score, and radiculopathy were weak or imprecise, whereas static morphology showed limited independent associations with clinical presentation. Cervical radiographs should be interpreted alongside history, examination, neurological findings, and patient-reported function, not as isolated explanations for symptoms.