European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Association between the anterior tilt slope and spinal sagittal parameters in asymptomatic adults from Southern China.
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Liao Changhe, Liang Haifeng, Yu XinMiao, Ye Tao, Gao Yingqi, Liang Shuang, Liu Dongjuan, He Shaojie, Wang Xiaowen, Lin Yuanfang, Ma Hangzhan
Аннотация
OBJECTIVE: To introduce and validate the Anterior Tilt Slope (ATS) as a novel angular parameter for quantifying cervical forward inclination in asymptomatic young adults, and to examine its associations with cervical and global spinal sagittal parameters.
METHODS: In this single-center retrospective study, 341 asymptomatic subjects (18-45 years) who underwent standing full-spine radiographs (AP/Lateral) between May 2023 and May 2025 were analyzed. Cervical parameters (CL, O-C2, C1-7, T1S, cSVA, Borden, ATS), thoracic kyphosis (TK), and spinopelvic parameters (LL, SS, PI, PT, SVA) were measured on PACS by two spine surgeons (twice, averaged). ATS was graded as type I < 5°, II 5-10°, III 10-15°, IV ≥ 15°. Normality was tested with Kolmogorov-Smirnov; group comparisons used t-test/ANOVA with Bonferroni; correlations used Pearson's r (two-tailed α = 0.05). Post hoc power analysis was performed.
RESULTS: The cohort included 119 males (39%) and 222 females (61%), mean age 25.17 years; overall ATS was 8.17 ± 4.63°. Distribution across ATS grades: I (n = 96), II (n = 134), III (n = 82), IV (n = 29). ATS correlated strongly with cSVA (r = 0.767, P < 0.01) and moderately with T1S (r = 0.482, P < 0.01), and positively with TK (r = 0.252, P < 0.01) and SVA (r = 0.187, P < 0.01); no significant correlations were observed with LL, PI, PT, SS, age, or sex (all P > 0.05). cSVA and T1S increased progressively with higher ATS grades (both P < 0.001). Sex-stratified analyses showed differences in CL, Borden, and C1-7 in certain grades, whereas ATS itself was sex-independent. Statistical power was adequate for main effects.
CONCLUSIONS: ATS provides a robust quantification of cervical forward inclination in asymptomatic individuals, closely linked to cSVA, T1S, and global sagittal alignment, with limited association to spinopelvic parameters-highlighting the pivotal role of the cervicothoracic junction in early sagittal compensation. ATS is a useful complement to cSVA for posture screening, outcome assessment, rehabilitation planning, and potentially surgical decision-making.
METHODS: In this single-center retrospective study, 341 asymptomatic subjects (18-45 years) who underwent standing full-spine radiographs (AP/Lateral) between May 2023 and May 2025 were analyzed. Cervical parameters (CL, O-C2, C1-7, T1S, cSVA, Borden, ATS), thoracic kyphosis (TK), and spinopelvic parameters (LL, SS, PI, PT, SVA) were measured on PACS by two spine surgeons (twice, averaged). ATS was graded as type I < 5°, II 5-10°, III 10-15°, IV ≥ 15°. Normality was tested with Kolmogorov-Smirnov; group comparisons used t-test/ANOVA with Bonferroni; correlations used Pearson's r (two-tailed α = 0.05). Post hoc power analysis was performed.
RESULTS: The cohort included 119 males (39%) and 222 females (61%), mean age 25.17 years; overall ATS was 8.17 ± 4.63°. Distribution across ATS grades: I (n = 96), II (n = 134), III (n = 82), IV (n = 29). ATS correlated strongly with cSVA (r = 0.767, P < 0.01) and moderately with T1S (r = 0.482, P < 0.01), and positively with TK (r = 0.252, P < 0.01) and SVA (r = 0.187, P < 0.01); no significant correlations were observed with LL, PI, PT, SS, age, or sex (all P > 0.05). cSVA and T1S increased progressively with higher ATS grades (both P < 0.001). Sex-stratified analyses showed differences in CL, Borden, and C1-7 in certain grades, whereas ATS itself was sex-independent. Statistical power was adequate for main effects.
CONCLUSIONS: ATS provides a robust quantification of cervical forward inclination in asymptomatic individuals, closely linked to cSVA, T1S, and global sagittal alignment, with limited association to spinopelvic parameters-highlighting the pivotal role of the cervicothoracic junction in early sagittal compensation. ATS is a useful complement to cSVA for posture screening, outcome assessment, rehabilitation planning, and potentially surgical decision-making.