{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:52:51Z","timestamp":1785909171605,"version":"3.56.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>While age-adjusted alignment goals are established for the lumbar spine, analogous clinically actionable tools are lacking for cervical sagittal assessment. This study aimed to derive and internally assess simple, age- and sex-specific formulas for key cervical parameters\u2014thoracic inlet angle minus cervical lordosis (TIA-CL), neck tilt (NT), and cervical sagittal vertical axis (cSVA)\u2014in asymptomatic adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study analyzed 632 rigorously screened asymptomatic adults (268 males, 364 females; mean age 54.8 \u00b1 16.6 years) who underwent neutral lateral cervical radiography. Radiographic parameters (TIA, C2\u2013C7 lordosis, NT, cSVA) were measured using a validated protocol. All angular parameters (TIA, CL, TIA-CL, and NT) are reported in degrees (\u00b0), whereas cSVA is reported in millimeters (mm). Sex-stratified linear regression models quantified age-related associations for TIA-CL, NT, and cSVA, with internal resampling via 1,000-iteration bootstrap resampling (CI width &amp;lt; 0.15 indicating good stability).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All three parameters showed significant positive associations with age (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). The derived simplified formulas were: TIA-CL \u2248 56 + 0.07 \u00d7 Age (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.010), NT \u2248 40 + 0.16 \u00d7 Age (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.111), and cSVA \u2248 15 + 0.10 \u00d7 Age (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.045). Age-associated differences were more pronounced for NT before age 50 (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.005) and for cSVA after age 50 (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.028). Males had significantly higher baseline NT and cSVA than females (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009 and\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Bootstrap resampling demonstrated internal consistency of the model estimates (all 95% CI widths &amp;lt; 0.15).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We provide age- and sex-specific reference formulas for NT and cSVA, and an age-specific formula for TIA-CL. These intuitive equations offer a practical reference for comparing an individual\u2019s alignment against age-associated population estimates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1856814","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:41:47Z","timestamp":1785908507000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Age-associated differences in cervical sagittal alignment parameters among asymptomatic adults: a cross-sectional reference study"],"prefix":"10.3389","volume":"20","author":[{"given":"Yu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Spinal Surgery, The People\u2019s Hospital of Yudu County, Ganzhou","place":["Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, The People\u2019s Hospital of Yudu County, Ganzhou","place":["Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjie","family":"Li","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Peking University Health Science Center, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Ruan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Peking University Health Science Center, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]},{"name":"Department of Orthopaedics, Beijing Tsinghua Changgung Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1007\/s00402-020-03667-1","article-title":"Analysis of the risk factors for increasing cervical sagittal vertical axis after cervical laminoplasty for cervical spondylotic myelopathy.","volume":"142","author":"Abe","year":"2022","journal-title":"Arch. 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