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Study design <p>Retrospective Cohort Study.</p> Background <p>Cervical sagittal alignment plays a critical role in global spinal balance and postural stability. Among the cervical parameters, the T1 slope has recently emerged as a potential biomechanical link between the cervical spine and lumbopelvic region. However, its behavior and clinical associations in non-deformed adult populations remain unclear.</p> Methods <p>This retrospective radiographic study included 200 non-deformed adults aged 40–60 years who underwent standing full-spine lateral radiographs. Cervical (C2–C7 Cobb angle, C7 slope, T1 slope) and spinopelvic (pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis) parameters were measured by two independent observers (ICC = 0.92). Pearson and Spearman correlation tests were used to assess associations, while subgroup comparisons were performed using Mann–Whitney U tests.</p> Results <p>The C2–C7 Cobb angle was significantly higher in participants aged ≥ 51 years those with degenerative disc disease. However, it showed no correlation with spinopelvic parameters. In contrast, T1 slope demonstrated strong positive correlations with lumbar lordosis sacral slope C7 slope, and age. T1 slope values were significantly lower in individuals over 51 years, and in those with degenerative disc disease or hypolordosis.</p> Conclusion <p>Our findings suggest that T1 slope serves as a biomechanical transition zone influenced by lumbopelvic alignment. While C2–C7 Cobb angle appears more responsive to age-related degeneration, T1 slope may offer earlier radiographic clues regarding sagittal compensation capacity. Integrating T1 slope into routine assessments could enhance clinical decision-making in spine evaluation.</p>

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Sagittal cervical and spinopelvic alignment in non-deformed adults: the role of T1 slope and C2–C7 Cobb angle

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Mustafa Bulut,
  • Muhammed Furkan Darilmaz,
  • Mustafa Arik,
  • Caglar Tuna Issi

摘要

Study design

Retrospective Cohort Study.

Background

Cervical sagittal alignment plays a critical role in global spinal balance and postural stability. Among the cervical parameters, the T1 slope has recently emerged as a potential biomechanical link between the cervical spine and lumbopelvic region. However, its behavior and clinical associations in non-deformed adult populations remain unclear.

Methods

This retrospective radiographic study included 200 non-deformed adults aged 40–60 years who underwent standing full-spine lateral radiographs. Cervical (C2–C7 Cobb angle, C7 slope, T1 slope) and spinopelvic (pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis) parameters were measured by two independent observers (ICC = 0.92). Pearson and Spearman correlation tests were used to assess associations, while subgroup comparisons were performed using Mann–Whitney U tests.

Results

The C2–C7 Cobb angle was significantly higher in participants aged ≥ 51 years those with degenerative disc disease. However, it showed no correlation with spinopelvic parameters. In contrast, T1 slope demonstrated strong positive correlations with lumbar lordosis sacral slope C7 slope, and age. T1 slope values were significantly lower in individuals over 51 years, and in those with degenerative disc disease or hypolordosis.

Conclusion

Our findings suggest that T1 slope serves as a biomechanical transition zone influenced by lumbopelvic alignment. While C2–C7 Cobb angle appears more responsive to age-related degeneration, T1 slope may offer earlier radiographic clues regarding sagittal compensation capacity. Integrating T1 slope into routine assessments could enhance clinical decision-making in spine evaluation.