Changes in Cervical Posture, Cervical Function, and Neck Pain After Sleeve Gastrectomy

Evaluation of Cervical Posture, Cervical Function, and Neck Pain After Laparoscopic Sleeve Gastrectomy: A Prospective Study

Obesity may contribute to neck pain, altered cervical posture, and impaired cervical function through increased mechanical loading, changes in body alignment, and reduced muscle performance. Although laparoscopic sleeve gastrectomy can produce substantial weight loss, its effects on cervical posture and neck-related function have not been studied comprehensively.

This prospective, single-center study will include approximately 25 adults who are already scheduled to undergo laparoscopic sleeve gastrectomy as part of their routine clinical care. The decision to perform surgery and the surgical procedure itself will not be assigned or modified by the study. Participants will be evaluated before surgery and at 3, 6, and 12 months after surgery.

Study assessments will include neck-related disability, neck pain intensity, quality of life, cervical range of motion, cervical muscle strength and endurance, and cervical joint position sense. Existing preoperative lateral cervical radiographs will be reviewed, and a lateral cervical radiograph will be obtained at the 12-month follow-up to assess cervical spinal alignment.

The primary outcome will be the change in Neck Disability Index scores across the scheduled study assessments. The study aims to determine whether weight loss following laparoscopic sleeve gastrectomy is associated with changes in cervical posture, neck pain, and cervical function.

Study Overview

• Status: Not yet recruiting
• Conditions: Neck Pain Musculoskeletal; Morbid Obesity Requiring Bariatric Surgery
• Intervention / Treatment: Procedure: Laparoscopic Sleeve Gastrectomy

Detailed Description

Obesity may affect the cervical spine through increased mechanical loading, anterior displacement of the body's center of gravity, postural adaptations, systemic inflammation, and impaired cervical muscle function. Although improvements in low back pain and other musculoskeletal symptoms have been reported following bariatric surgery, prospective evidence regarding cervical posture, neck pain, and cervical function after laparoscopic sleeve gastrectomy remains limited.

This is a prospective, single-center study involving adults with obesity who have been scheduled to undergo laparoscopic sleeve gastrectomy based on routine clinical indications. The decision to perform surgery will be made independently of the research protocol. The study will not alter the surgical procedure or assign any experimental drug, treatment, or device.

Approximately 25 participants will be enrolled, with the aim of obtaining at least 20 participants who complete the study follow-up. Assessments will be performed before surgery and at 3, 6, and 12 months after surgery.

Neck-related disability will be assessed using the Neck Disability Index. Neck pain intensity will be measured using a Visual Analog Scale or Numerical Rating Scale, and health-related quality of life will be evaluated using the 12-Item Short Form Health Survey. Cervical range of motion will be measured with an inclinometer. Isometric cervical muscle strength will be assessed using a MicroFET3 handheld dynamometer. Cervical muscle endurance will be evaluated using the craniocervical flexion test with a pressure biofeedback stabilizer, together with cervical flexor and extensor endurance tests. Cervical proprioception will be assessed using a laser-based joint position error test.

Only participants with an existing lateral cervical radiograph obtained before study enrollment for a reason unrelated to the research will be eligible. No additional preoperative cervical radiograph will be obtained solely for the study. At the 12-month follow-up, one lateral cervical radiograph will be obtained to assess cervical sagittal alignment. The C2-C7 Cobb lordosis angle and C2-C7 sagittal vertical axis will be measured using standardized digital measurement methods by the same radiologist.

The primary analysis will evaluate changes in Neck Disability Index scores across the scheduled study visits. Secondary analyses will evaluate changes in neck pain intensity, cervical range of motion, cervical muscle strength, cervical muscle endurance, proprioception, quality of life, and radiographic cervical alignment. Associations between the amount of weight loss and changes in cervical pain, posture, and function will also be explored.

• Study Type: Observational
• Enrollment (Estimated): 25

Contacts and Locations

• Study Contact: Name: Kubra Neslihan Kurt Oktay, MD; Phone Number: +905352916609; Email: drneslihankurt@gmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34668
      • University of Health Sciences, Haydarpasa Numune Training and Research Hospital
      • Contact: Kubra Neslihan Kurt Oktay, MD; Phone Number: +905352916609; Email: drneslihankurt@gmail.com
      • Principal Investigator: Kubra Neslihan Kurt Oktay, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of adults with obesity who have been scheduled to undergo laparoscopic sleeve gastrectomy based on routine clinical indications at the Bariatric Surgery Unit of Haydarpasa Numune Training and Research Hospital. Eligible patients must have a previously obtained lateral cervical radiograph available in the hospital information system or national electronic health record.

Description

Inclusion Criteria:

• Adults aged 18 to 65 years
• Obesity with a clinical indication for bariatric surgery
• Scheduled to undergo laparoscopic sleeve gastrectomy at Haydarpasa Numune Training and Research Hospital
• Availability of a previously obtained lateral cervical radiograph in the hospital information system or national electronic health record
• Willingness and ability to attend the preoperative and 3-, 6-, and 12-month follow-up assessments
• Provision of written informed consent

Exclusion Criteria:

• Previous cervical spine surgery
• Acute cervical trauma, cervical fracture, or severe cervical deformity
• Diagnosed inflammatory rheumatic disease, such as rheumatoid arthritis or ankylosing spondylitis
• History of a neurological disorder, such as multiple sclerosis, myopathy, or peripheral neuropathy
• Malignancy or advanced systemic disease, such as advanced heart failure or renal failure
• Pregnancy or breastfeeding
• Inability to attend the scheduled follow-up visits

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Participants Undergoing Laparoscopic Sleeve Gastrectomy; Adults with obesity who are scheduled to undergo laparoscopic sleeve gastrectomy based on routine clinical indications. Participants will be evaluated before surgery and at 3, 6, and 12 months after surgery to assess changes in cervical posture, neck pain, and cervical function. The decision to perform surgery and the surgical procedure will not be assigned or modified by the research protocol.

Procedure: Laparoscopic Sleeve Gastrectomy; Laparoscopic sleeve gastrectomy will be performed by the bariatric surgery team according to routine clinical indications and standard institutional practice. The decision to perform surgery, the surgical technique, and perioperative management will not be assigned or modified by the study protocol. The study will prospectively assess changes in cervical posture, neck pain, cervical disability, and cervical function following the procedure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Neck Disability Index (NDI) Score	The Neck Disability Index is a 10-item self-reported questionnaire used to assess neck-related disability. Each item is scored from 0 to 5, resulting in a total score ranging from 0 to 50, with higher scores indicating greater disability. Neck Disability Index scores will be recorded at the preoperative baseline assessment and at the scheduled postoperative follow-up visits. Changes in scores across the study assessments will be analyzed.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Neck Pain Intensity at Rest and During Activity	Neck pain intensity at rest and during activity will be assessed separately using an 11-point Numerical Rating Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Participants will provide separate ratings for resting neck pain and activity-related neck pain at each scheduled assessment. Changes in the two scores across the study visits will be analyzed separately, with lower scores indicating less pain.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Cervical Range of Motion	Cervical range of motion will be measured in degrees using an inclinometer. Measurements will include cervical flexion, extension, right and left lateral flexion, and right and left rotation. Each movement direction will be recorded and analyzed separately at the scheduled study assessments. Higher values indicate a greater range of motion. Changes in each cervical range-of-motion measurement across the study visits will be analyzed.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Cervical Muscle Strength	Cervical muscle strength will be assessed using a MicroFET3 handheld dynamometer and recorded in newtons. Maximal isometric strength of the cervical flexor and extensor muscles will be measured separately at each scheduled assessment. Changes in flexor and extensor strength across the study visits will be analyzed separately. Higher values indicate greater cervical muscle strength.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Cervical Muscle Endurance	Cervical muscle endurance will be assessed using the craniocervical flexion test with a pressure biofeedback device and a timed cervical extensor endurance test. Flexor and extensor endurance results will be recorded in seconds and analyzed separately at each scheduled assessment. Higher values indicate greater cervical muscle endurance.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Cervical Proprioception	Cervical proprioception will be assessed using a Joint Position Error test. Repositioning error will be recorded in degrees at each scheduled assessment. Changes in Joint Position Error measurements across the study visits will be analyzed. Lower values indicate more accurate cervical repositioning and better proprioceptive performance.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Health-Related Quality of Life	Health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12). The Physical Component Summary and Mental Component Summary scores will be calculated and analyzed separately at each scheduled assessment. Higher scores indicate better health-related quality of life. Changes in both component scores across the study visits will be analyzed.	Preoperative baseline and 3, 6, and 12 months after laparoscopic sleeve gastrectomy
Change in Radiographic Cervical Sagittal Alignment	adiographic cervical sagittal alignment will be evaluated on lateral cervical radiographs using the C2-C7 Cobb lordosis angle and the C2-C7 sagittal vertical axis. The C2-C7 Cobb lordosis angle will be measured in degrees, and the C2-C7 sagittal vertical axis will be measured as a linear distance in millimeters. Both parameters will be measured separately using standardized digital measurement tools by the same radiologist. Changes from the preoperative radiograph to the 12-month postoperative radiograph will be analyzed separately for each parameter.	Preoperative existing lateral cervical radiograph and 12 months after laparoscopic sleeve gastrectomy

Collaborators and Investigators

• Sponsor: Haydarpasa Numune Training and Research Hospital

Publications and helpful links

General Publications

• Marques C, Granstrom E, MacDowall A, Moreira NC, Skeppholm M, Olerud C. Accuracy and Reliability of X-ray Measurements in the Cervical Spine. Asian Spine J. 2020 Apr;14(2):169-176. doi: 10.31616/asj.2019.0069. Epub 2019 Nov 1.
• Ergin A, Ergin E, Atasever A, Ciyiltepe H, Fersahoglu MM, Esen Bulut N, Tasdelen I, Gunes Y, Teke E, Yilmaz C, Illeez O, Usta B, Sancak S. Investigation of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study. Surg Obes Relat Dis. 2023 Dec;19(12):1357-1365. doi: 10.1016/j.soard.2023.07.010. Epub 2023 Aug 4.
• Cakir T, Oruc MT, Aslaner A, Duygun F, Yardimci EC, Mayir B, Bulbuller N. The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients. Int J Clin Exp Med. 2015 Feb 15;8(2):2668-73. eCollection 2015.

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): January 1, 2028

Study Registration Dates

• First Submitted: September 4, 2026
• First Submitted That Met QC Criteria: September 4, 2026
• First Posted (Actual): September 10, 2026

Study Record Updates

• Last Update Posted (Actual): September 10, 2026
• Last Update Submitted That Met QC Criteria: September 4, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: Weight Loss; Bariatric Surgery; Neck Disability Index; Laparoscopic Sleeve Gastrectomy; Cervical Posture; Cervical Proprioception; Joint Position Error; Cervical Lordosis; Cervical Range of Motion; Cervical Muscle Strength; Cervical Muscle Endurance; Cervical Sagittal Alignment; Cervical Function
• Additional Relevant MeSH Terms: Body Weight; Body Weight Changes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Weight Loss
• Other Study ID Numbers: 2024-KAEK-18-08

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be publicly shared because of participant confidentiality and institutional data-protection requirements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No