{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:47:17Z","timestamp":1793108837275,"version":"4.5.0"},"reference-count":22,"publisher":"The Korean Spinal Neurosurgery Society","issue":"4","license":[{"start":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T00:00:00Z","timestamp":1672444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-neurospine.org"],"crossmark-restriction":true},"short-container-title":["Neurospine"],"published-print":{"date-parts":[[2022,12,31]]},"abstract":"<jats:p>Objective: The role of the craniocervical complex in spinal sagittal alignment has rarely been analyzed but it may play a fundamental role in postoperative mechanical complications. The aim of the study is to analyze the normative value of the cervical inclination angle (CIA) in an adult asymptomatic multiethnic population.Methods: Standing full-spine EOS of adult asymptomatic volunteers from 5 different countries were analyzed. The CIA was analyzed globally and then in each decade of life. Different ethnicities were compared. Comparisons between different groups was performed using a t-test and statistical significance was considered with a p-value &lt; 0.05.Results: EOS of 468 volunteers were analyzed. The global mean CIA was 80.2\u00b0 with a maximum difference of 9\u00b0 between T1 and T12 (p &lt; 0.001). The CIA remains constant until 60 years old then decreases significantly passing from a mean value before 20 years old of 82.25\u00b0 to 73.65\u00b0 after 70 years old. A statistically significant difference was found between the Arabics and other ethnicities with the formers having an inferior CIA: this was related to a mean older age (p &lt; 0.05) and higher body mass index (p &lt; 0.05) in the Arabics.Conclusion: The CIA remains constant until 60 years old and then reduces slightly but never under 70\u00b0. This angle is helpful to evaluate the lever arm at the upper instrumented vertebra after an adult spinal deformity surgery and could predict the occurrence of a proximal junctional kyphosis when its value is lower than normal. Further clinical studies must confirm this theory.<\/jats:p>","DOI":"10.14245\/ns.2244892.446","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T05:29:52Z","timestamp":1672032592000},"page":"883-888","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cervical Inclination Angle: Normative Values in an Adult Multiethnic Asymptomatic Population"],"prefix":"10.14245","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0463-6706","authenticated-orcid":true,"given":"Jean Charles Le","family":"Huec","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8417-3798","authenticated-orcid":true,"given":"Zeeshan M.","family":"Sardar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8604-9486","authenticated-orcid":true,"given":"Emanuele","family":"Quarto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5931-7067","authenticated-orcid":true,"given":"Meghan","family":"Cerpa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8459-7136","authenticated-orcid":true,"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6246-6960","authenticated-orcid":true,"given":"Kazuhiro","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2012-9835","authenticated-orcid":true,"given":"Hwee Weng","family":"Dennis Hey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1176-1238","authenticated-orcid":true,"given":"Hee-Kit","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1929-1122","authenticated-orcid":true,"given":"Hend","family":"Riahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5595-4958","authenticated-orcid":true,"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4385-3172","authenticated-orcid":true,"given":"St\u00e9phane","family":"Bourret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"MEANS study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5355","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1326950"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000160842.43482.cd"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2015.12.009"},{"key":"ref4","first-page":"2093","volume-title":"Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development","author":"Lau","year":"2014"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-019-06083-1"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2017.07.234"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5826-3"},{"key":"ref8","first-page":"87","volume-title":"Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal disease: a literature review","author":"Le Huec","year":"2015"},{"key":"ref9","first-page":"479","volume-title":"","author":"Dubousset","year":"1994"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1177\/2192568219882350"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.22603\/ssrr.2020-0093"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2016.05.008"},{"key":"ref13","first-page":"1643","volume-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","author":"Glattes","year":"2005"},{"key":"ref14","first-page":"1479","volume-title":"Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up","author":"Yagi","year":"2012"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0b013e31815a5a9d"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-020-06320-y"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5425-8"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5426-7"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5111-x"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4830-8"},{"key":"ref21","first-page":"829","volume-title":"Results of the 2014 SRS Survey on PJK\/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development","author":"Scheer","year":"2015"},{"key":"ref22","first-page":"S144","volume-title":"Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review","author":"Kim","year":"2012"}],"container-title":["Neurospine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2244892-446.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2244892.446","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-2244892-446.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T22:58:24Z","timestamp":1672613904000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.2244892.446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,31]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,12]]}},"URL":"https:\/\/doi.org\/10.14245\/ns.2244892.446","relation":{},"ISSN":["2586-6583","2586-6591"],"issn-type":[{"value":"2586-6583","type":"print"},{"value":"2586-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,31]]},"assertion":[{"value":"2022-10-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-31","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}