{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:13:37Z","timestamp":1786122817955,"version":"build-2736575974"},"reference-count":134,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CBP NonProfit, Inc."},{"name":"Australian Spine Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The biomedical literature assessing the reliability of mensuration of sagittal cervical spine alignment in radiographs has not been systematically evaluated. This review aims to systematically identify and assess reliability studies on biomechanical assessments of the sagittal cervical spine used in clinical practice. Methods: The study design was registered with PROSPERO (CRD42023402990). Funding was obtained from Chiropractic BioPhysics (CBP) Non-Profit (Eagle, ID, USA). Inclusion criteria involved studies in English with: human subjects, radiography of the sagittal cervical spine, and reliability analysis of biomechanical mensuration of the sagittal cervical spine. Exclusion criteria involved studies with: geometric modeling, animals, cadavers, phantom mannequins, and non-radiographic studies. PubMed, CINAHL, AltHealthWatch, and Web of Science databases were searched from inception through to 24 January 2023. The quality appraisal tool for studies of diagnostic reliability (QAREL) assessed bias risk. Results: We followed the synthesis without meta-analysis (SWiM) according to systematic review guidelines. Scrutiny of the inclusion criteria yielded 51 articles. The results were limited due to the heterogeneity of various mensuration methods (Cobb, posterior tangent, translation measures, etc.) and the incorporation of both manual and digital measured assessments. Other sources of heterogeneity included the quality and type of images used, whether digital or plain film radiographs were used, and the differences in statistical analysis and reporting (ICCs or Pearson correlation coefficients, Cohen\u2019s kappa agreement, or Bland\u2013Altman plots). Still, the preponderance of evidence found good-to-excellent reliability. Conclusions: This SROL discovered good-to-excellent intra-examiner reliability for the following biomechanical mensuration methods: intersegmental rotation angles, the thoracic inlet angle, the T1 slope, the C2\u2013C7 posterior tangent method for total cervical lordosis, and the Cobb C2\u2013C7 method for total cervical lordosis. Likewise, using these criteria, we identified good-to-excellent inter-examiner reliability for the following biomechanical mensuration methods: intersegmental rotation angles, the thoracic inlet angle, the T1 slope, translation using the sagittal vertical axis of C2\u2013C7, the C2\u2013C7 posterior tangent method for total cervical lordosis, and the Cobb C2\u2013C7 method for total cervical lordosis.<\/jats:p>","DOI":"10.3390\/jcm15166146","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:44:53Z","timestamp":1786103093000},"page":"6146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Reliability of Biomechanical Mensuration Methods of the Sagittal Cervical Spine in Radiography Used in Clinical Practice: A Systematic Review of the Literature"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3325-7246","authenticated-orcid":false,"given":"Douglas F.","family":"Lightstone","sequence":"first","affiliation":[{"name":"Institute for Spinal Health and Performance, Cumming, GA 30041, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4162-2418","authenticated-orcid":false,"given":"Joseph W.","family":"Betz","sequence":"additional","affiliation":[{"name":"Private Practice, Boise, ID 83702, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Haas","sequence":"additional","affiliation":[{"name":"Chiropractic Biophysics NonProfit, Eagle, ID 83616, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3117-7330","authenticated-orcid":false,"given":"Paul A.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Ferrantelli","sequence":"additional","affiliation":[{"name":"PostureCo, Trinity, FL 34655, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4859-1490","authenticated-orcid":false,"given":"Ibrahim M.","family":"Moustafa","sequence":"additional","affiliation":[{"name":"Neuromusculoskeletal Rehabilitation Research Group, RIMHS\u2014Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-7106","authenticated-orcid":false,"given":"Deed E.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Chiropractic Biophysics NonProfit, Eagle, ID 83616, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Shin, D.W., Shin, J.I., Koyanagi, A., Jacob, L., Smith, L., Lee, H., Chang, Y., and Song, T.-J. (2022). Global, regional, and national neck pain burden in the general population, 1990\u20132019: An analysis of the global burden of disease study 2019. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.955367"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kazeminasab, S., Nejadghaderi, S.A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M.J.M., Kolahi, A.-A., and Safiri, S. (2022). Neck pain: Global epidemiology, trends and risk factors. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-021-04957-4"},{"key":"ref_3","unstructured":"GBD 2021 Neck Pain Collaborators (2024). Global, regional, and national burden of neck pain, 1990\u20132020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol., 6, e142\u2013e155."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Igwesi-Chidobe, C.N., Effiong, E., Umunnah, J.O., and Ozumba, B.C. (2024). Occupational biopsychosocial factors associated with neck pain intensity, neck-disability, and sick leave: A cross-sectional study of construction labourers in an African population. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0295352"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Harrison, D.E., Oakley, P.A., and Moustafa, I.M. (2023). Don\u2019t throw the \u2018Bio\u2019 out of the Bio-Psycho-Social model: Editorial for spine rehabilitation in 2022 and beyond. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175602"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1136\/bjsports-2018-099569","article-title":"Is kinesiophobia and pain catastrophising at baseline associated with chronic pain and disability in whiplash-associated disorders? A systematic review","volume":"54","author":"Falla","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1007\/s00586-017-5433-8","article-title":"The Global Spine Care Initiative: Applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities","volume":"27","author":"Chou","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jbiomech.2015.10.035","article-title":"Fundamental biomechanics of the spine\u2014What we have learned in the past 25 years and future directions","volume":"49","author":"Oxland","year":"2016","journal-title":"J. Biomech."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.2214\/ajr.150.6.1223","article-title":"Spine imaging: History, achievements, remaining frontiers","volume":"150","author":"Hesselink","year":"1988","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00586-014-3542-1","article-title":"Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions","volume":"24","author":"Ferrer","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/BRS.0000000000002370","article-title":"Spinopelvic changes based on the simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships with disability and health-related quality of life in adult patients with prolonged degenerative spinal disorders","volume":"43","author":"Repo","year":"2018","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3171\/2014.11.SPINE1441","article-title":"How the neck affects the back: Changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up","volume":"23","author":"Protopsaltis","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s00586-018-5462-y","article-title":"Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review","volume":"27","author":"Ling","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Moustafa, I.M., Shousha, T., Arumugam, A., and Harrison, D.E. (2023). Is thoracic kyphosis relevant to pain, autonomic nervous system function, disability, and cervical sensorimotor control in patients with chronic nonspecific neck pain?. J. Clin. Med., 12.","DOI":"10.20944\/preprints202304.0745.v1"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kaale, B.R., McArthur, T.J., Barbosa, M.H., and Freeman, M.D. (2023). Post-traumatic atlanto-axial instability: A combined clinical and radiological approach for the diagnosis of pathological rotational movement in the upper cervical spine. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041469"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Moustafa, I.M., Diab, A.A.M., and Harrison, D.E. (2022). Does improvement towards a normal cervical sagittal configuration aid in the management of lumbosacral radiculopathy: A randomized controlled trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195768"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Arnone, P.A., Kraus, S.J., Farmen, D., Lightstone, D.F., Jaeger, J., and Theodossis, C. (2023). Examining clinical opinion and experience regarding utilization of plain radiography of the spine: Evidence from surveying the chiropractic profession. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062169"},{"key":"ref_18","unstructured":"Bernardo-Filho, M. (2021). The influence of sagittal plane spine alignment on neurophysiology and sensorimotor control measures: Optimization of function through structural correction. Therapy Approaches in Neurological Disorders, IntechOpen."},{"key":"ref_19","unstructured":"Kuo, D.T., and Tadi, P. (2026, January 31). Cervical spondylosis, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK551557\/."},{"key":"ref_20","unstructured":"Torlincasi, A.M., and Waseem, M. (2026, January 31). Cervical injury, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448146\/."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kim, H.J., Virk, S., Elysee, J., Ames, C., Passias, P., Shaffrey, C., Mundis, G., Protopsaltis, T., Gupta, M., and Klineberg, E. (2021). Surgical strategy for the management of cervical deformity is based on type of cervical deformity. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214826"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Foley, D., Hardacker, P., and McCarthy, M. (2023). Emerging technologies within spine surgery. Life, 13.","DOI":"10.3390\/life13102028"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Liu, C., Zhu, W., Li, Y., Li, X., Shi, B., Kong, C., and Lu, S. (2024). How does cervical sagittal profile change after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07518-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jclinepi.2016.01.021","article-title":"PRESS peer review of electronic search strategies: 2015 guideline statement","volume":"75","author":"McGowan","year":"2016","journal-title":"J. Clin. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.3174\/ajnr.A3585","article-title":"Evaluation of the intervertebral disk angle for the assessment of anterior cervical diskoligamentous injury","volume":"34","author":"Alhilali","year":"2013","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e598","DOI":"10.1097\/SCS.0000000000004644","article-title":"Changes in cervical lordosis after orthognathic surgery in skeletal class III patients","volume":"29","author":"Andriola","year":"2018","journal-title":"J. Craniofacial Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1097\/BRS.0000000000004375","article-title":"Assessing postoperative pseudarthrosis in anterior cervical discectomy and fusion (ACDF) on dynamic radiographs using novel angular measurements","volume":"47","author":"Balouch","year":"2022","journal-title":"Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1007\/s00586-017-4957-2","article-title":"Reliability and scientific use of a surgical planning software for anterior cervical discectomy and fusion (ACDF)","volume":"26","author":"Barth","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.spinee.2020.07.003","article-title":"The mandible-C2 angle: A new radiographic assessment of occipitocervical alignment","volume":"21","author":"Bellabarba","year":"2021","journal-title":"Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1097\/BRS.0b013e318221e169","article-title":"Reproducibility of radiographic measurements for subaxial cervical spine trauma","volume":"36","author":"Bono","year":"2011","journal-title":"Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/00007632-200301010-00012","article-title":"Pseudoarthrosis of the cervical spine: A comparison of radiographic diagnostic measures","volume":"28","author":"Cannada","year":"2003","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1007\/s00586-020-06415-6","article-title":"Occipitocervical measurements: Correlation and consistency between multi-positional magnetic resonance imaging and dynamic radiographs","volume":"29","author":"Chamnan","year":"2020","journal-title":"Eur. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1007\/s00586-005-0927-1","article-title":"Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies","volume":"15","author":"Champain","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11596-012-0021-y","article-title":"Accuracy and repeatability of computer aided cervical vertebra landmarking in cephalogram","volume":"32","author":"Chen","year":"2012","journal-title":"J. Huazhong Univ. Sci. Technol. Med. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1097\/00007632-199704150-00007","article-title":"Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs?","volume":"22","author":"Cassidy","year":"1997","journal-title":"Spine"},{"key":"ref_37","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":"Daffin","year":"2019","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"572","DOI":"10.3171\/2016.10.SPINE16632","article-title":"An assessment of the most reliable method to estimate the sagittal alignment of the cervical spine: Analysis of a prospective cohort of 138 cases","volume":"26","author":"Donk","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/01.bpo.0000242443.42176.67","article-title":"Digital radiographic measurement of the atlantodental interval in children","volume":"27","author":"Douglas","year":"2007","journal-title":"J. Pediatr. Orthop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/00007632-198807000-00007","article-title":"Functional radiographic diagnosis of the cervical spine: Flexion\/extension","volume":"13","author":"Dvorak","year":"1988","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0268-0033(01)00105-X","article-title":"Sagittal plane segmental motion of the cervical spine. A new precision measurement protocol and normal motion data of healthy adults","volume":"17","author":"Frobin","year":"2002","journal-title":"Clin. Biomech."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jmpt.2013.09.002","article-title":"Reliability of the craniocervical posture assessment: Visual and angular measurements using photographs and radiographs","volume":"36","author":"Gadotti","year":"2013","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jmpt.2012.12.009","article-title":"Assessment of intrasubject reliability of radiographic craniocervical posture of asymptomatic female subjects","volume":"36","author":"Gadotti","year":"2013","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"105229","DOI":"10.1016\/j.jbspin.2021.105229","article-title":"Reproducibility and diagnostic value of a new method using ratios to diagnose anterior atlanto-axial subluxation on plain radiographs","volume":"88","author":"Guyard","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"667","DOI":"10.3171\/2009.7.SPINE08656","article-title":"Effective lordosis: Analysis of sagittal spinal canal alignment in cervical spondylotic myelopathy","volume":"11","author":"Gwinn","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1097\/00007632-199707010-00009","article-title":"Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms","volume":"22","author":"Hardacker","year":"1997","journal-title":"Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1097\/00007632-200008150-00011","article-title":"Cobb method or Harrison posterior tangent method: Which to choose for lateral cervical radiographic analysis","volume":"25","author":"Harrison","year":"2000","journal-title":"Spine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1097\/01.rct.0000120855.80935.2f","article-title":"Computed tomography contrast enhancement principles and the use of high-concentration contrast media","volume":"28","author":"Herman","year":"2004","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_49","first-page":"384","article-title":"Chiropractic biophysics lateral cervical film analysis reliability","volume":"16","author":"Jackson","year":"1993","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3596","DOI":"10.1007\/s00586-015-4345-8","article-title":"Reliability of cervical lordosis measurement techniques on long-cassette radiographs","volume":"25","author":"Janusz","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Jiang, S.D., Chen, J.W., Yang, Y.H., Chen, X.D., and Jiang, L.S. (2014). Intraobserver and interobserver reliability of measures of cervical sagittal rotation. BMC Musculoskelet. Disord., 15.","DOI":"10.1186\/1471-2474-15-332"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1097\/00007632-199804150-00015","article-title":"The correlation between surface measurement of head and neck posture and the anatomic position of the upper cervical vertebrae","volume":"23","author":"Johnson","year":"1998","journal-title":"Spine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/BF00298389","article-title":"Radiographic evaluation of the upper cervical spine in rheumatoid arthritis: A retrospective analysis","volume":"5","author":"Kuhr","year":"1996","journal-title":"Eur. Spine J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s00590-016-1881-9","article-title":"A new method for measurement of occipitocervical angle by occiput-C3 angle","volume":"27","author":"Kunakornsawat","year":"2017","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1016\/j.spinee.2015.08.067","article-title":"Validation of a new computer-assisted tool to measure spino-pelvic parameters","volume":"15","author":"Lafage","year":"2015","journal-title":"Spine J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1097\/BRS.0000000000002256","article-title":"Comparative Analysis of Three Imaging Modalities for Evaluation of Cervical Sagittal Alignment Parameters: A Validity and Reliability Study","volume":"42","author":"Lee","year":"2017","journal-title":"Spine"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00586-008-0877-5","article-title":"Interobserver reliability and intra-observer reproducibility of powers ratio for assessment of atlanto-occipital junction: Comparison of plain radiography and computed tomography","volume":"18","author":"Li","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.spinee.2020.10.021","article-title":"Laminoplasty\u2014An underutilized procedure for cervical spondylotic myelopathy","volume":"21","author":"Lopez","year":"2021","journal-title":"Spine J."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Manabe, A., Ishida, T., Kanda, E., and Ono, T. (2022). Evaluation of maxillary and mandibular growth patterns with cephalometric analysis based on cervical vertebral maturation: A Japanese cross-sectional study. PLoS ONE, 17.","DOI":"10.21203\/rs.3.rs-1505014\/v1"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0009-9260(96)80156-5","article-title":"The role of radiology in the investigation and management of patients with haemoptysis","volume":"51","author":"Marshall","year":"1996","journal-title":"Clin. Radiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"E1566","DOI":"10.1097\/BRS.0000000000000625","article-title":"Novel 2 radiographical measurements for atlantoaxial instability in children with Down syndrome","volume":"39","author":"Nakamura","year":"2014","journal-title":"Spine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00586-017-5306-1","article-title":"Can multi-positional magnetic resonance imaging be used to evaluate angular parameters in cervical spine? A comparison of multi-positional MRI to dynamic plain radiograph","volume":"27","author":"Paholpak","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1097\/00007632-199904150-00008","article-title":"Occipitocervical neutral position. Possible surgical implications","volume":"24","author":"Phillips","year":"1999","journal-title":"Spine"},{"key":"ref_64","first-page":"498","article-title":"A retrospective consecutive case analysis of pretreatment and comparative static radiological parameters following chiropractic adjustments","volume":"13","author":"Plaugher","year":"1990","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_65","first-page":"23","article-title":"Inter- and intra-examiner reliability of the upper cervical x-ray marking system: A third and expanded look","volume":"3","author":"Rochester","year":"1994","journal-title":"Chiropr. Res. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"103026","DOI":"10.1016\/j.otsr.2021.103026","article-title":"Reliability assessment of cervical spine parameters measured on full-body radiographs in asymptomatic subjects and patients with spinal deformity","volume":"107","author":"Salameh","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"E282","DOI":"10.1097\/BSD.0000000000000105","article-title":"The reliabilities of radiographic measurements of cervical sagittal alignment in ankylosing spondylitis","volume":"29","author":"Shin","year":"2016","journal-title":"Clin. Spine Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"E204","DOI":"10.1097\/00007632-200405150-00022","article-title":"Measurement of occipitocervical angle","volume":"29","author":"Shoda","year":"2004","journal-title":"Spine"},{"key":"ref_69","first-page":"75","article-title":"Inter- and intra-examiner reliability of the upper cervical X-ray marking system","volume":"8","author":"Sigler","year":"1985","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/01.bsd.0000095824.98982.53","article-title":"Measurement variability in the assessment of sagittal alignment of the cervical spine: A comparison of the gore and cobb methods","volume":"17","author":"Silber","year":"2004","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1258\/ar.2011.110230","article-title":"Motion analysis of total cervical disc replacements using computed tomography: Preliminary experience with nine patients and a model","volume":"52","author":"Svedmark","year":"2011","journal-title":"Acta Radiol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Tang, C., Yang, S., Liao, Y.H., Tang, Q., Ma, F., Wang, Q., and Zhong, D.J. (2020). A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03398-9"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1007\/s00586-013-2752-2","article-title":"Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis","volume":"22","author":"Vidal","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/01241398-200001000-00015","article-title":"Intraobserver reproducibility and interobserver reliability of cervical spine measurements","volume":"20","author":"Wellborn","year":"2000","journal-title":"J. Pediatr. Orthop."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.spinee.2013.06.097","article-title":"The reproducibility comparison of two intervertebral translation measurements in cervical flexion-extension","volume":"15","author":"Wu","year":"2015","journal-title":"Spine J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"19579","DOI":"10.1038\/s41598-022-21660-z","article-title":"Validity and reliability of a novel iPhone method to rapidly measure cervical sagittal parameters","volume":"12","author":"Zhang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"187","DOI":"10.4103\/picr.PICR_123_17","article-title":"Common pitfalls in statistical analysis: Measures of agreement","volume":"8","author":"Ranganathan","year":"2017","journal-title":"Perspect. Clin. Res."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Alfuth, M., Fichter, P., and Knicker, A. (2021). Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0261457"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jht.2017.06.010","article-title":"What is the reliability of clinical measurement tests for humeral head position? A systematic review","volume":"30","author":"Konieczka","year":"2017","journal-title":"J. Hand Ther."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1213\/ANE.0000000000001596","article-title":"Publication bias: The elephant in the review","volume":"123","author":"Dalton","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1002\/jrsm.1369","article-title":"The value of a second reviewer for study selection in systematic reviews","volume":"10","author":"Stoll","year":"2019","journal-title":"Res. Synth. Methods"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1017\/nws.2019.21","article-title":"Endnote: Feature-based classification of networks","volume":"7","author":"Barnett","year":"2019","journal-title":"Netw. Sci."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12998-020-00323-8","article-title":"The clinical utility of routine spinal radiographs by chiropractors: A rapid review of the literature","volume":"28","author":"Corso","year":"2020","journal-title":"Chiropr. Man. Ther."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"28","DOI":"10.25259\/JCIS_68_2024","article-title":"An investigation into the chiropractic practice and communication of routine, repetitive radiographic imaging for the location of postural misalignments","volume":"14","author":"Williams","year":"2024","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_86","first-page":"103","article-title":"Ionizing radiation exposure\u2014More good than harm? The preponderance of evidence does not support abandoning current standards and regulations","volume":"50","author":"Bussieres","year":"2006","journal-title":"J. Can. Chiropr. Assoc."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jmpt.2007.11.003","article-title":"Diagnostic imaging practice guidelines for musculoskeletal complaints in adults\u2014An evidence-based approach\u2014Part 3: Spinal disorders","volume":"31","author":"Bussieres","year":"2008","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12998-018-0217-8","article-title":"Current evidence for spinal X-ray use in the chiropractic profession: A narrative review","volume":"26","author":"Jenkins","year":"2018","journal-title":"Chiropr. Man. Ther."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Hosseini, M.M., Mahoor, M.H., Haas, J.W., Ferrantelli, J.R., Dupuis, A.L., Jaeger, J.O., and Harrison, D.E. (2024). Intra-examiner reliability and validity of sagittal cervical spine mensuration methods using deep convolutional neural networks. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092573"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1177\/21925682241227428","article-title":"Novel AI-Based Algorithm for the Automated Measurement of Cervical Sagittal Balance Parameters. A Validation Study on Pre- and Postoperative Radiographs of 129 Patients","volume":"15","author":"Vogt","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_91","first-page":"e27696","article-title":"Reliability and validity of non-radiographic methods of forward head posture measurement: A Systematic Review","volume":"5","author":"Mylonas","year":"2022","journal-title":"Cureus"},{"key":"ref_92","first-page":"2323","article-title":"Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders","volume":"22","author":"Assendelft","year":"2003","journal-title":"Spine"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.jmpt.2008.10.004","article-title":"Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health","volume":"31","author":"Christensen","year":"2008","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Haas, J.W., Oakley, P.A., Ferrantelli, J.R., Katz, E.A., Moustafa, I.M., and Harrison, D.E. (2024). Abnormal static sagittal cervical curvatures following motor vehicle collisions: A retrospective case series of 41 patients before and after a crash exposure. Diagnostics, 14.","DOI":"10.20944\/preprints202402.1175.v1"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0974-8237.199877","article-title":"Loss of cervical lordosis: What is the prognosis?","volume":"8","author":"Lippa","year":"2017","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Suzuki, H., Funaba, M., Fujimoto, K., Ichihara, Y., Nishida, N., and Sakai, T. (2024). Current concepts of cervical spine alignment, sagittal deformity, and cervical spine surgery. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051196"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"960","DOI":"10.14444\/8325","article-title":"Perioperative change in cervical lordosis and health-related quality-of-life outcomes","volume":"16","author":"Canseco","year":"2022","journal-title":"Int. J. Spine Surg."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e585","DOI":"10.5435\/JAAOS-D-23-00565","article-title":"Cervical sagittal alignment and related factor analysis and prediction model in patients undergoing revision surgery after anterior cervical fusion","volume":"32","author":"Romani","year":"2024","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Figas, G., Kostka, J., Pikala, M., Kujawa, J.E., and Adamczewski, T. (2024). Analysis of clinical pattern of musculoskeletal disorders in the cervical and cervico-thoracic regions of the spine. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030840"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"11781","DOI":"10.1038\/s41598-024-62812-7","article-title":"Utilizing machine learning to predict post-treatment outcomes in chronic non-specific neck pain patients undergoing cervical extension traction","volume":"14","author":"Moustafa","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"e943057","DOI":"10.12659\/MSM.943057","article-title":"Comparative analysis of postoperative sagittal balance in expansive open-door laminoplasty versus laminectomy with fusion for multilevel ossification of posterior longitudinal ligament: A retrospective study","volume":"30","author":"Ma","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"432892","DOI":"10.6064\/2012\/432892","article-title":"The impact of primary care: A focused review","volume":"2012","author":"Shi","year":"2012","journal-title":"Scientifica"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"15593258211033142","DOI":"10.1177\/15593258211033142","article-title":"Radiophobia overreaction: College of chiropractors of British Columbia revoke full x-ray rights based on flawed study and radiation fear-mongering","volume":"19","author":"Oakley","year":"2021","journal-title":"Dose-Response"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Jung, J.Y., Lee, Y.B., and Kang, C.K. (2024). Effect of forward head posture on resting state brain function. Healthcare, 12.","DOI":"10.3390\/healthcare12121162"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"559","DOI":"10.13075\/ijomeh.1896.01585","article-title":"The impact of the position of the head on the functioning of the human body: A systematic review","volume":"33","author":"Fudacz","year":"2020","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jelekin.2013.05.009","article-title":"Differential effects of mental concentration and acute psychosocial stress on cervical muscle activity and posture","volume":"23","author":"Shahidi","year":"2013","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1007\/s12178-019-09594-y","article-title":"The relationship between forward head posture and neck pain: A systematic review and meta-analysis","volume":"12","author":"Mahmoud","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/bc.bc_25_18","article-title":"Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis","volume":"5","author":"Katz","year":"2019","journal-title":"Brain Circ."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"495","DOI":"10.12659\/MSM.897500","article-title":"Decreased vertebral artery hemodynamics in patients with loss of cervical lordosis","volume":"22","author":"Bulut","year":"2016","journal-title":"Med. Sci. Monit."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e36845","DOI":"10.1097\/MD.0000000000036845","article-title":"Effects of cervical stabilization with visual feedback on craniovertebral angle and proprioception for the subjects with forward head posture","volume":"103","author":"Goo","year":"2024","journal-title":"Medicine"},{"key":"ref_111","first-page":"73","article-title":"Evaluation of the Craniovertebral Angle in Standing versus Sitting Positions in Young Adults with and without Severe Forward Head Posture","volume":"17","author":"Titcomb","year":"2024","journal-title":"Int. J. Exerc. Sci."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1589\/jpts.31.63","article-title":"Effect of forward head posture on thoracic shape and respiratory function","volume":"31","author":"Koseki","year":"2019","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e570","DOI":"10.1016\/j.wneu.2024.07.178","article-title":"Posterior Circulation Ischemic Stroke Is Associated with More Severe Forward Head Posture in Patients with Cervicalgia","volume":"190","author":"Behzadi","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1589\/jpts.33.784","article-title":"Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: A systematic review of controlled trials","volume":"33","author":"Oakley","year":"2021","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00586-017-5367-1","article-title":"Cervical sagittal balance: A biomechanical perspective can help clinical practice","volume":"27","author":"Patwardhan","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"15379","DOI":"10.1038\/s41598-021-94548-z","article-title":"Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial","volume":"11","author":"Moustafa","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Norton, T.C., Oakley, P.A., Haas, J.W., and Harrison, D.E. (2023). Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics\u00ae Methods: A Pre-Auto Injury and Post-Auto Injury Case Series. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196414"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"e14393","DOI":"10.1097\/MD.0000000000014393","article-title":"Correlation of cervical and thoracic inlet sagittal parameters by MRI and radiography in patients with cervical spondylosis","volume":"98","author":"Cheng","year":"2019","journal-title":"Medicine"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00586-023-07997-7","article-title":"A novel classification that defines the normal cervical spine: An analysis based on 632 asymptomatic Chinese volunteers","volume":"33","author":"Zhang","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Mekhael, E., El Rachkidi, R., Saliby, R.M., Nassim, N., Semaan, K., Massaad, A., Karam, M., Saade, M., Ayoub, E., and Rteil, A. (2023). Functional assessment using 3D movement analysis can better predict health-related quality of life outcomes in patients with adult spinal deformity: A machine learning approach. Front. Surg., 10.","DOI":"10.3389\/fsurg.2023.1166734"},{"key":"ref_121","first-page":"58","article-title":"Significance of Machine Learning in Healthcare: Features, Pillars and Applications","volume":"3","author":"Javaid","year":"2022","journal-title":"Int. J. Intell. Netw."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1097\/j.pain.0000000000002922","article-title":"Genetic risk shared across 24 chronic pain conditions: Identification and characterization with genomic structural equation modeling","volume":"164","author":"Bango","year":"2023","journal-title":"Pain"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"921","DOI":"10.31616\/asj.2020.0647","article-title":"Cervical radiculopathy focus on characteristics and differential diagnosis","volume":"14","author":"Kang","year":"2020","journal-title":"Asian Spine J."},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Kotecki, M., Gasik, R., G\u0142uszko, P., and Sudo\u0142-Szopi\u0144ska, I. (2021). Radiological evaluation of cervical spine involvement in rheumatoid arthritis: A cross-sectional retrospective study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194587"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s13018-018-0854-6","article-title":"Cervical lordosis in asymptomatic individuals: A meta-analysis","volume":"13","author":"Guo","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_126","first-page":"1666","article-title":"The relationship between cervical lordosis and neck pain: A systematic review and meta-analysis","volume":"8","author":"Kim","year":"2024","journal-title":"Appl. Sci. Tech."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1097\/00007632-199603150-00002","article-title":"Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine","volume":"21","author":"Harrison","year":"1996","journal-title":"Spine"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"2485","DOI":"10.1097\/01.brs.0000144449.90741.7c","article-title":"Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: Results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects","volume":"29","author":"Harrison","year":"2004","journal-title":"Spine"},{"key":"ref_129","first-page":"100819","article-title":"A systematic review and meta-analysis of sagittal cervical spine parameters: Normative values, correlation with quality of life, and biomechanical modeling","volume":"25","author":"Ferraz","year":"2025","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"28563","DOI":"10.1038\/s41598-024-79181-w","article-title":"Sagittal alignment to predict efficiency in pulsed radiofrequency for cervical facet joint pain","volume":"14","author":"Yen","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"3225","DOI":"10.1111\/os.13552","article-title":"Preoperative Cervical Cobb Angle Is a Risk Factor for Postoperative Axial Neck Pain after Anterior Cervical Discectomy and Fusion with Zero-Profile Interbody","volume":"14","author":"Cao","year":"2022","journal-title":"Orthop. Surg."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.2147\/JPR.S303979","article-title":"Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study","volume":"14","author":"Liang","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.jclinepi.2021.04.012","article-title":"Restricting evidence syntheses of interventions to English-language publications is a viable methodological shortcut for most medical topics: A systematic review","volume":"137","author":"Dobrescu","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_134","unstructured":"Viswanathan, M., Patnode, C.D., Berkman, N.D., Bass, E.B., Chang, S., Hartling, L., Murad, M.H., Treadwell, J.R., and Kane, R.L. (2026, January 31). Assessing the Risk of Bias in Systematic Reviews of Health Care Interventions, Methods Guide for Effectiveness and Comparative Effectiveness Reviews [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519366\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:54:53Z","timestamp":1786103693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":134,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166146"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166146","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}