Objective To investigate the effect of cervical Pavlov ratio on cervical degeneration and cervical-related clinical manifestations in young and middle-aged military population.Methods The demographic, imaging and clinical data of 18-40 years old military patients mainly complaining "neck pain" longer than 3 months were collected from Jan. 2021 to Aug. 2021. All samples were grouped by systematic cluster analysis according to X-ray measurement data. The bone degeneration, intervertebral disc degeneration and neck disability index (NDI) scores of the groups were compared and analyzed.Results A total of 129 cases (all males) were included. The samples were divided into 3 groups:high Pavlov ratio group (1.12-1.23[1.18±0.04], 21 cases), medium Pavlov ratio group (0.83-1.11[0.96±0.06], 84 cases) and low Pavlov ratio group (0.69-0.82[0.77±0.04], 24 cases). There were significant differences in vertebra diameter (VD), canal diameter (CD), lateral mass width (LM), spinolaminar line-to-lateral mass distance (SL), Pavlov ratio, LM/SL ratio, bone degeneration, Pfirrmann grade and Kang grade among the 3 groups (all P < 0.05). High Pavlov ratio group mainly manifested low VD, high CD and SL, with most serious bone degeneration; medium Pavlov ratio group showed high LM and LM/SL ratio, with the lightest bone degeneration; and low Pavlov ratio group presented high VD, low CD and SL, with the highest Pfirrmann grade and Kang grade. No significant difference was observed in age, lordosis or NDI score among the 3 groups (all P>0.05). There was no significant correlation between overall Pavlov ratio and NDI score (r=-0.035, P=0.691). A positive correlation between Pavlov ratio and NDI score in the high Pavlov ratio group (r=0.541, P=0.011) and a negative correlation in the low Pavlov ratio group (r=-0.642, P=0.001) were demonstrated, without significant correlation in the medium Pavlov ratio group (r=-0.057, P=0.604).Conclusion Compared with patients of medium Pavlov ratio, the patients of high or low ratio present unbalanced development of vertebra and vertebral arch and more obvious degeneration of bone and intervertebral disc, and the severity of clinical symptoms increases with the escalation of the deviation trend of the Pavlov ratio. Pavlov ratio can be used as a high-risk anatomic factor for the neck pain and cervical spine degeneration, or as a reference selection index to measure the competency of specific posts in the army.