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Xu et al. | Journal of Clinical and Translational Research 2023; 9(5): 340-346 345
forward to support the head, thereby increasing C2-7 CA and on Standing Balance. Gait Posture 2018;62:227-34.
C2-7 SVA, meanwhile, the more kyphotic the thoracic spine, the [2] Jeon CH, Kwack KS, Park S, Lee HD, Chung NS.
lower the degree of lordosis in the lumbar spine. Moreover, the Combination of Whole-Spine Lateral Radiograph and
retroverted pelvis, which manifests over time, pushes the trunk Lateral Scanogram in the Assessment of Global Sagittal
forward and thus elevates the C7-S1 SVA. This mechanism may Balance. Spine J 2018;18:255-60.
explain the upward trend of correlations between cervical and [3] Aulisa L, Pitta L, Padua R, Ceccarelli E, Aulisa A,
distal spinal alignment with aging. Leone A. Biomechanics of the Spine. Rays 2000;25:11-8.
In addition, the correlations between TIA and TK in the four
groups were significant, but no trends were observed with aging. [4] Tan LA, Riew KD, Traynelis VC. Cervical Spine
Deformity-Part 1: Biomechanics, Radiographic Parameters,
This result revealed that the correlation between TIA and TK and Classification. Neurosurgery 2017;81:197-203.
was consistent and not influenced by aging. Correspondingly,
the correlation between TS and TK showed an increasing trend [5] Alijani B, Rasoulian J. The Sagittal Balance of the Cervical
with aging, which implied that the impact of TK on TS was more Spine: Radiographic Analysis of Interdependence between
pronounced than TIA during the aging process. the Occipitocervical and Spinopelvic Alignment. Asian
Finally, there were some limitations in this study that needs to Spine J 2020;14:287-97.
be taken into consideration. To begin, the sample size of this study [6] Tang Y, Zhao W, Liu X, Yu M. Normative Values of
was relatively small, and more subjects need to be enrolled in Cervical Sagittal Alignment According to Global Spine
future studies to reach credible conclusions. Second, the patients Balance: Based on 126 Asymptomatic Chinese Young
were enrolled from South China, and hence, our findings may not Adults. Eur Spine J 2021;30:2427-33.
be generalizable to the global population. Therefore, future studies [7] Chen Y, Luo J, Pan Z, Yu L, Pang L, Zhong J, et al. The
should enroll participants from different regions and ethnicities. Change of Cervical Spine Alignment Along with Aging in
Asymptomatic Population: A Preliminary Analysis. Eur
5. Conclusion Spine J 2017;26:2363-71.

The alignments of the subaxial cervical spine are closely [8] Lee SH, Son ES, Seo EM, Suk KS, Kim KT. Factors
correlated with distal spinal sagittal alignment during the aging Determining Cervical Spine Sagittal Balance in
process in the asymptomatic population. In addition, an increasing Asymptomatic Adults: Correlation with Spinopelvic Balance
trend with aging was observed in the correlations between C2-7 and Thoracic Inlet Alignment. Spine J 2015;15:705-12.
CA and TK, C2-7 SVA and SS, and C2-7 SVA and C7-S1 SVA. [9] Núñez-Pereira S, Hitzl W, Bullmann V, Meier O,
Koller H. Sagittal Balance of the Cervical Spine: An Analysis
Acknowledgments of Occipitocervical and Spinopelvic Interdependence,
None. with C-7 Slope as a Marker of Cervical and Spinopelvic
Alignment. J Neurosurg Spine 2015;23:16-23.
Funding [10] Okubo T, Yagi M, Suzuki S, Takahashi Y, Nori S,
This work was funded by Double-thousand Plan Program of Tsuji O, et al. Cervical Sagittal Alignment is Influenced
Jiangxi Province (jxsq2023201023) and Clinical Cultivation by Changes in Thoracic and Lumbar Sagittal Alignments
Project of The First Affiliated Hospital of Nanchang University after Correction Surgery in Patients with Lenke Type 6
(No.YFYLCYJPY202202). Adolescent Idiopathic Scoliosis. N Am Spine Soc J
2022;12:100166.
Conflicts of Interest [11] Yan P, Zhang Y, Liu S, Shu S, Liu Z, Zhu Z, et al. Sagittal
Profile Response of Cervical Spine After Posterior
The authors declare no conflicts of interest in this research.
Correction in Thoracic and Lumbar Adolescent Idiopathic
Ethics Approval and Consent to Participate Scoliosis: Correlation with Thoracic Kyphosis? World
Neurosurg 2018;120:e333-41.
This study was approved by Institutional Review Board of The [12] Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T,
First Affiliated Hospital of Nanchang University, and informed Yoshida M. Normative Data for Parameters of Sagittal
consent was obtained from the patients by the authors. Spinal Alignment in Healthy Subjects: An Analysis
Consent for Publication of Gender Specific Differences and Changes with
Aging in 626 Asymptomatic Individuals. Eur Spine J
Consent was given by the patients to publish their data and 2018;27:426-32.
images in this paper. [13] Videman T, Battié MC, Gill K, Manninen H, Gibbons LE,
References Fisher LD. Magnetic Resonance Imaging Findings and
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DOI: http://dx.doi.org/10.18053/jctres.09.202305.23-00059