The effect of smartphone texting on cervical spine sagittal alignment in healthy young adults.

Background: Never before has technology been so universally accepted as the modern-era cell phone, the smartphone. Spine surgeons have noticed a rise in patients in their offices complaining of neck and upper back pain. Many patients are of the younger age group, and one thing they all seem to have in common is prolonged smartphone use. While using a smartphone, the cervical spine demonstrates flexion angles ranging from 15 to 60 degrees, with more pronounced deviations from the neutral position observed during sitting compared to standing, and while texting compared to web browsing or video watching. Nowadays, there is strong evidence that persistent neck pain and radiculopathy are associated with time spent text messaging. While it now seems rather clear that repetitive texting, or similar activity while utilizing a forward flexed neck position, may lead to neck pain or "text neck", what is currently unknown is whether this poses a risk for intervertebral disk degeneration and consequent cervical spondylosis, and if so, at what age the condition will emerge and which levels of the cervical spine will it affect the most. The aim of this study was to evaluate the effects of smartphone texting on cervical spine sagittal alignment in healthy young adults, and to identify which cervical segments are most affected, particularly comparing sitting versus standing postures. Methods: We took lateral radiographs of the cervical spine of healthy volunteers younger than 40 years old. The radiographs were made while texting on a smartphone and in a neutral position, sitting and standing. Then we measured the disc angles, vertebral angles, and sagittal angles on each radiograph. Results: When texting while standing, significant (P≤0.05) changes in the intervertebral angles (IVAs) were seen at foramen magnum (FM)-C2, FM-C3, FM-C4, C1-2, C2-4, C2-T1, C3-4, C3-5, C3-6, C3-7 and C3-T1. The significant changes in the interdiscal angles (IDAs) were seen at C3-4, C4-5. No significant changes were seen in the angle of lordosis (AOL). When texting while sitting, the significant (P≤0.05) changes in the IVAs were at IVAs: FM-C2, FM-C3, FM-C4, C1-2, C1-3, C1-4, C2-7, C2-T1, C3-4, C3-5, C3-6 and C5-7. The significant changes in the IDAs were at C3-4, C5-6. No significant changes were seen in the AOL. Conclusions: Our observation shows that the most significant changes in the cervical spine while texting occur in the upper segments of the cervical spine, more pronounced while sitting.