Association between cervical sagittal alignment, neck awareness, and disability in chronic neck pain: The possible role of probable sleep bruxism

Abstract

Background Chronic neck pain (CNP) is a major cause of disability. Cervical sagittal alignment, neck awareness, and probable sleep bruxism may influence symptom burden. Methods This cross-sectional study included 76 patients (18–60 years) with CNP. Probable sleep bruxism was classified using self/partner report and clinical findings. Pain was rated on a visual analog scale (VAS), neck awareness by the Fremantle Neck Awareness Questionnaire–Turkish (FreNAQ-T), and disability by the Neck Disability Index (NDI). Lateral radiographs provided C0–2 and C2–7 Cobb angles, cervical sagittal vertical axis (cSVA), T1 slope (T1S), T1S–cervical lordosis (T1S–CL) mismatch and cervical tilt. Results Thirty-six patients had probable sleep bruxism. Patients with probable sleep bruxism were younger, more often desk-based workers, and had higher educational levels (p = 0.002, p = 0.002, and p = 0.008, respectively). They also had higher NDI scores (p = 0.043) and greater cSVA (p = 0.045). In the overall cohort, FreNAQ-T correlated with NDI (r = 0.585, p < 0.001), and night pain correlated with FreNAQ-T (r = 0.266, p = 0.020) and NDI (r = 0.253, p = 0.028). In patients without probable sleep bruxism, C2–7 Cobb angle correlated with T1S (r = 0.322, p = 0.035) and T1S–CL mismatch (r = −0.718, p < 0.001). In those with probable sleep bruxism, night pain correlated with C2–7 Cobb angle (r = −0.347, p = 0.038) and cSVA (r = 0.336, p = 0.045). Conclusion Probable sleep bruxism was associated with higher disability and greater anterior cervical sagittal translation in CNP. Subgroup-specific correlation patterns suggest associations among sagittal alignment, neck awareness, and symptom burden; however, causality cannot be inferred.