{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T14:36:56Z","timestamp":1793975816179,"version":"4.8.0"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,22]],"date-time":"2022-05-22T00:00:00Z","timestamp":1653177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The cranial vertical angle (CVA) and cranial rotation angle (CRA) are used in clinical settings because they can be measured on lateral photographs of the head and neck. We aimed to clarify the relationship between CVA and CRA photographic measurements and radiographic cervical spine alignment. Twenty-six healthy volunteers were recruited for this study. Lateral photographs and cervical spine radiographs were obtained in the sitting position. The CVA and CRA were measured using lateral photographs of the head and neck. The C2-7 sagittal vertical axis (SVA), cervical lordosis (C2-7), and occipito-C2 lordosis (O-C2) were measured using radiographic imaging as a standard method of evaluating cervical spine alignment. Correlations between the CVA and CRA on photographs and cervical spine alignment on radiographs were analyzed. The CVA and SVA were significantly negatively correlated (\u03c1 = \u22120.51; p &lt; 0.05). Significant positive correlations were found between CVA and C2-7 (\u03c1 = 0.59; p &lt; 0.01) and between CRA and O-C2 (\u03c1 = 0.65; p &lt; 0.01). Evaluating the CVA and CRA on photographs may be useful for ascertaining head and neck alignment in the mid-lower and upper parts of the sagittal plane.<\/jats:p>","DOI":"10.3390\/ijerph19106278","type":"journal-article","created":{"date-parts":[[2022,5,22]],"date-time":"2022-05-22T07:13:57Z","timestamp":1653203637000},"page":"6278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Correlation between the Photographic Cranial Angles and Radiographic Cervical Spine Alignment"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4807-1508","authenticated-orcid":false,"given":"Tomoko","family":"Kawasaki","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"},{"name":"Hiro-o Orthopedics Clinic, Tokyo 1500012, Japan"},{"name":"Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo 1138519, Japan"},{"name":"Division of Physical Therapy, Tokyo Metropolitan University, Tokyo 1168551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Ohji","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"},{"name":"Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo 1138519, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Aizawa","sequence":"additional","affiliation":[{"name":"Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo 1138519, Japan"},{"name":"Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 1138421, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Hirohata","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"},{"name":"Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo 1138519, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Kuruma","sequence":"additional","affiliation":[{"name":"Division of Physical Therapy, Tokyo Metropolitan University, Tokyo 1168551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohisa","family":"Koseki","sequence":"additional","affiliation":[{"name":"Hiro-o Orthopedics Clinic, Tokyo 1500012, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Okawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Jinno","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 1138510, Japan"},{"name":"Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama 3438555, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2008.0303","article-title":"Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association","volume":"38","author":"Childs","year":"2008","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/oem.60.9.649","article-title":"Risk Factors in the Onset of Neck\/Shoulder Pain in a Prospective Study of Workers in Industrial and Service Companies","volume":"60","author":"Andersen","year":"2003","journal-title":"Occup. Environ. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.math.2006.11.002","article-title":"The Relationship Between Head Posture and Severity and Disability of Patients with Neck Pain","volume":"13","author":"Yip","year":"2008","journal-title":"Man. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3109\/09593985.2015.1099172","article-title":"Measurement of Craniovertebral Angle by the Modified Head Posture Spinal Curvature Instrument: A Reliability and Validity Study","volume":"32","author":"Subbarayalu","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jmpt.2005.02.015","article-title":"Determining the Relationship Between Cervical Lordosis and Neck Complaints","volume":"28","author":"McAviney","year":"2005","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1097\/BRS.0000000000001644","article-title":"Variations in Occipitocervical and Cervicothoracic Alignment Parameters Based on Age: A Prospective Study of Asymptomatic Volunteers Using Full-Body Radiographs","volume":"41","author":"Iyer","year":"2016","journal-title":"Spine"},{"key":"ref_7","first-page":"1","article-title":"Low-Dose Extrapolation of Radiation-Related Cancer Risk","volume":"35","author":"Valentin","year":"2005","journal-title":"Ann. ICRP"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13013-017-0135-x","article-title":"Non-Radiographic Methods of Measuring Global Sagittal Balance: A Systematic Review","volume":"12","author":"Cohen","year":"2017","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.12968\/ijtr.2009.16.1.37939","article-title":"Head Posture Assessment for Patients with Neck Pain: Is It Useful?","volume":"16","author":"Silva","year":"2009","journal-title":"Int. J. Ther. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gallego-Izquierdo, T., Arroba-D\u00edaz, E., Garc\u00eda-Ascoz, G., and Val-Cano, M. (2020). del A.; Pecos-Martin, D.; Cano-de-la-Cuerda, R. Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186521"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.msksp.2019.05.003","article-title":"Internal and external sagittal craniovertebral alignment: A comparison between radiological and photogrammetric approaches in asymptomatic participants","volume":"43","author":"Lee","year":"2019","journal-title":"Musculoskelet Sci. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/ptj\/78.4.395","article-title":"The Relationship Between Head and Neck Posture and VDT Screen Height in Keyboard Operators","volume":"78","author":"Kietrys","year":"1998","journal-title":"Phys. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_14","first-page":"105","article-title":"Clinical photographs in the assessment of adult spinal deformity: A comparison to radiographic parameters","volume":"35","author":"Ryan","year":"2021","journal-title":"J. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A Power Primer","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol. Bull."},{"key":"ref_16","unstructured":"UNSCEAR 2000 Report-Vol (2022, March 24). I. Available online: https:\/\/www.unscear.org\/unscear\/en\/publications\/2000_1.html."},{"key":"ref_17","first-page":"256","article-title":"Clinical Photography: A Guide for the Clinician","volume":"49","author":"Nayler","year":"2003","journal-title":"J. Postgrad. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1590\/bjpt-rbf.2014.0027","article-title":"Cervical and Shoulder Postural Assessment of Adolescents Between 15 and 17 Years Old and Association with Upper Quadrant Pain","volume":"18","author":"Ruivo","year":"2014","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1213\/ANE.0b013e3182110f9f","article-title":"Identification of the Correct Cervical Level by Palpation of Spinous Processes","volume":"112","author":"Shin","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1589\/jpts.25.7","article-title":"The Effects of Cervical Mobilization Combined with Thoracic Mobilization on Forward Head Posture of Neck Pain Patients","volume":"25","author":"Lee","year":"2013","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E720","DOI":"10.1097\/BRS.0b013e3181f9f714","article-title":"Impact of the O-C2 Angle on the Oropharyngeal Space in Normal Patients","volume":"36","author":"Ota","year":"2011","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E154","DOI":"10.1097\/BRS.0000000000002253","article-title":"Global Spinal Alignment in Patients with Cervical Spondylotic Myelopathy","volume":"43","author":"Yoshida","year":"2018","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3171\/2013.4.SPINE12838","article-title":"Cervical Spine Alignment, Sagittal Deformity, and Clinical Implications: A Review","volume":"19","author":"Scheer","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","first-page":"131","article-title":"The Role of C2\u2013C7 and O\u2013C2 Angle in the Development of Dysphagia After Cervical Spine Surgery","volume":"28","author":"Tian","year":"2013","journal-title":"Dysphagia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"311","DOI":"10.14245\/ns.2040700.350","article-title":"Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty","volume":"18","author":"Ono","year":"2021","journal-title":"Neurospine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.22603\/ssrr.2017-0060","article-title":"The Reliabilities of Several Measurement Methods of Cervical Sagittal Alignment in Cases with Cervical Spine Rotation Using X-Ray Findings in Cervical Spine Disorders","volume":"2","author":"Yo","year":"2018","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/2192568218811841","article-title":"Evaluating Cervical Sagittal Alignment in Cervical Myelopathy: Are Sitting Cervical Radiographs and Standing Whole-Spine Radiographs Equally Useful?","volume":"9","author":"Morimoto","year":"2019","journal-title":"Glob. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2519\/jospt.1996.23.6.353","article-title":"Clinical Measurement of Head and Shoulder Posture Variables","volume":"23","author":"Harrison","year":"1996","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1682\/JRRD.2010.01.0001","article-title":"Measurement of Craniovertebral Angle with Electronic Head Posture Instrument: Criterion Validity","volume":"47","author":"Lau","year":"2010","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/00007632-199902010-00008","article-title":"Cervical Flexion, Extension, Protrusion, and Retraction: A Radiographic Segmental Analysis","volume":"24","author":"Ordway","year":"1999","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/S0003-9993(97)90335-X","article-title":"Head and Shoulder Posture Variations in 160 Asymptomatic Women and Men","volume":"78","author":"Raine","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_32","first-page":"416","article-title":"Craniocervical Posture: Cephalometric and Biophotogrammetric Analysis","volume":"11","author":"Weber","year":"2012","journal-title":"Braz. J. Oral Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:16:19Z","timestamp":1760138179000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,22]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19106278"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19106278","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,22]]}}}