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Determining the Reference Values of the Measurements of Cervical Sagittal Alignment Using the Extrapolated Norms

Shenyan Gu1, Kaiwen Chen1, Dongqing Zhu2

  • 1Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.

World Neurosurgery
|June 29, 2025
PubMed
Summary

The extrapolated norms (e-norms) method provides a reliable way to establish cervical sagittal alignment reference ranges. This approach reveals age and sex-specific differences in spinal alignment.

Keywords:
Age-related changeCervical sagittal alignmentE-normsReference valuesSex difference

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Area of Science:

  • Orthopedics
  • Radiology
  • Biomedical Engineering

Background:

  • Cervical sagittal alignment is crucial for spinal health.
  • Establishing accurate reference ranges is essential for diagnosing and managing spinal conditions.
  • Current methods for determining reference ranges can be complex and costly.

Purpose of the Study:

  • To assess the feasibility of the extrapolated norms (e-norms) method for cervical sagittal alignment measurements.
  • To establish reference ranges for cervical sagittal alignment using the e-norms method.
  • To explore age and sex-based differences in these reference ranges.

Main Methods:

  • Applied the e-norms method to 1720 subjects to calculate reference values for occiput-C2 angle, C2-7 Cobb angle, C2-7 sagittal vertical axis, and C7 slope.
  • Analyzed e-norms values across different age and sex subgroups.

Main Results:

  • Established normal e-norms values: occiput-C2 angle (18.5±2.6°), C2-7 Cobb angle (8.8±4.5°), C2-7 sagittal vertical axis (1.5±0.4 cm), and C7 slope (20.1±3.5°).
  • Observed age-related increases in C2-7 Cobb angle and C7 slope in females, and C7 slope in males.
  • Identified significant sex-based differences in cervical sagittal measurements across age groups.

Conclusions:

  • The e-norms method is a feasible, reliable, and cost-effective approach for establishing cervical sagittal measurement reference values.
  • This method facilitates the creation of sex and age-specific reference values.
  • Enables better study of sex differences and age-related trends in cervical sagittal alignment.