What question did this study set out to answer?

The aim is to analyze normative sagittal alignment parameters of the cervical and cervicothoracic spine in asymptomatic adults.

April 4, 2026Open Access

Normative Cervical and Cervicothoracic Sagittal Alignment Parameters for Asymptomatic Adults: A Systematic Review and Meta-Analysis of >35,900 Participants

Puntos clave

The aim is to analyze normative sagittal alignment parameters of the cervical and cervicothoracic spine in asymptomatic adults.
Conducted a systematic review and meta-analysis of studies involving asymptomatic adults.
Collected data on demographic parameters like age, gender, and ethnicity.
Analyzed cervical and spinal parameters including C2 SVA, TPA, and cervical lordosis from various studies.
C2 SVA was found to be greater in men compared to women.
O-C2 and SSA decrease with age, while CL and C7 SVA increase with age.
Ethnic differences were noted in measurements like CL, with variations across Asian, Caucasian, and Middle Eastern groups.

Resumen

Study Design: Systematic review and meta-analysis. Objective: To provide a comprehensive analysis of normative cervical and cervicothoracic global alignment in asymptomatic volunteers. Background: Understanding normal sagittal parameters of the spine is integral for adults with spinal deformities and degenerative pathologies. Thorough understanding of cervical, cervicothoracic sagittal alignment is paramount for surgical planning. Materials and Methods: We queried PubMed for original studies on asymptomatic adults. The following parameters were collected: age range, gender percentage, study inclusion and exclusion criteria, and level of evidence. Cervical and global parameters included: occiput to C2 (O-C2), cervical lordosis (CL), C2-C7 sagittal vertical axis (C2 SVA), T1 slope (T1S), C7 SVA, T1 pelvic angle (TPA), and spinosacral angle (SSA). Data were analyzed according to sex, age, and ethnic group. Results: Our initial search resulted in 5453 citations for review. After exclusion criteria, 191 full articles were assessed. Articles came from 27 countries and included 35,913 participants: 16,125 men (44.9%), 18,222 women (50.7%), weighted average age: 45.9 years, age range: 18 to 93 years. Significant findings included: male/female C2 SVA: 2.04 cm (overall, CI: 1.82, 2.26), 2.39 cm (male, CI: 2.09, 2.69), 1.69 cm (female, CI: 1.46, 1.92). Age O-C2: −15.67 (20–40, CI: −14.88, −16.46), −13.77 (40–60, CI: −11.85, −15.68), −12.14 (>60, CI: −11.25, −13.02). CL: −7.61 (20–40, CI: −5.09, −10.13), −13.32 (40–60, CI: −10.87, −15.77), −15.96 (>60, CI: −14.36, −17.56). C7 SVA: 0.07 cm (20–40, CI: −0.54, 0.67), 0.84 cm (40–60, CI: 0.17, 1.51), 3.07 cm (>60, CI: 2.48, 3.66). TPA: 7.58 (20–40, CI: 6.38, 8.77), 9.08 (40–60, CI: 8.03, 10.13), 14.28 (>60, CI: 12.39, 16.17). SSA: 130.91 (20–40, CI: 130.06, 131.77), 130.45 (40–60, CI: 128.17, 132.72), 126.7 (>60, CI: 124.48, 128.92). Ethnic Group CL: Asians (−12.2±0.61) and Caucasians (−21.14±1.41) were both greater than Middle Easterners (−0.53, CI: 8.97, −10.04). Conclusion: C2 SVA was greater in men volunteers. O-C2 and SSA decreased with age, while CL, C7 SVA, and TPA increased. CL, C2 SVA, T1S, and C7 SVA all showed ethnicity-dependent differences, but global alignment was largely equivalent across broad ethnic groups. Level of Evidence: Level II.

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