{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:37:50Z","timestamp":1792841870381,"version":"4.5.0"},"reference-count":12,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Back and Musculoskeletal Rehabilitation"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical sagittal alignment is essential for proper load distribution and neural function. Alterations in the C2\u2013C7 lordotic angle or sagittal vertical axis (SVA) may contribute to pain, functional decline, or neurological symptoms, but their relative clinical significance remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine associations between C2\u2013C7 lordotic angle, sagittal vertical axis (SVA), and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study analyzed 130 outpatients undergoing lateral cervical radiography for neck pain. Patients were classified into normal lordosis (\u226510 \u00b0) and hypolordosis (&lt;10 \u00b0), and into three SVA groups (\u226420\u2005mm, 21\u201340\u2005mm, &gt;40\u2005mm). Outcomes included Numeric Rating Scale (NRS), Neck Disability Index (NDI), and patient-reported neurological symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hypolordosis was significantly associated with higher Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores, but neurological symptoms did not differ by lordosis. Increasing sagittal vertical axis (SVA) correlated strongly with disability and neurological deficits. Patients with sagittal vertical axis (SVA)\u2009&gt;\u200940\u2005mm had elevated odds of arm numbness (OR \u2248 13.8) and weakness (OR\u2009=\u20099.0; multivariate OR \u2248 8.1) compared with sagittal vertical axis (SVA)\u2009\u2264\u200920\u2005mm. Multivariate analyses identified lordotic angle as the strongest predictor of pain, whereas sagittal vertical axis (SVA) was the key determinant of disability and neurological symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The C2\u2013C7 lordotic angle and sagittal vertical axis (SVA) play complementary roles: lordosis predicts neck pain, while sagittal vertical axis (SVA) reflects disability and neurological risk. Routine assessment of both, particularly sagittal vertical axis (SVA), may aid clinical decision-making in cervical spine disorders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10538127261444790","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T13:50:47Z","timestamp":1777038647000},"page":"2030-2039","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["C2\u2013C7 sagittal alignment on lateral cervical X-rays and its correlation with neck pain, disability, and neurological symptoms"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9137-1002","authenticated-orcid":false,"given":"Hoon Sub","family":"Han","sequence":"first","affiliation":[{"name":"Department of Anatomy &amp; Cell Biology, College of Medicine, Hanyang University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3435-4195","authenticated-orcid":false,"given":"Won Kyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anatomy &amp; Cell Biology, College of Medicine, Hanyang University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8698-639X","authenticated-orcid":false,"given":"Yong Seok","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Kyungpook National University, Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182a7f449"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5367-1"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-020-01836-x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1930-3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31826100c9"},{"key":"e_1_3_3_7_2","first-page":"483","article-title":"Comparison of axial and flexural stresses in lordosis and kyphosis of the cervical spine","volume":"23","author":"Harrison DD","year":"2000","unstructured":"Harrison DD, Harrison DE, Janik TJ, et al. 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