A Cervical Lordosis Curvature Decline in Chinese Asymptomatic Populations from 2016 to 2024: A Comparative Analysis

A Cervical Lordosis Curvature Decline in Chinese Asymptomatic Populations from 2016 to 2024: A Comparative Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Cervical Lordosis Curvature Decline in Chinese Asymptomatic Populations from 2016 to 2024: A Comparative Analysis Xiang Liu, Wei-cong Zhang, Zhi-hai Su, Yun-chuan Bai, Xiao-jun Lu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7753732/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Feb, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract Background With the widespread increase in the use of electronic devices, there has been a growing concern regarding their potential impact on health, particularly concerning the cervical spine. The overuse of mobile phones has been associated with cervical spondylosis and other cervical spine disorders. This study sought to assess recent trends in cervical lordosis (CL) curvature over the past eight years. Methods Asymptomatic individuals who underwent cervical spine radiography at four hospitals were randomly selected from hospital databases for a comparative analysis of data spanning from 2016 to 2024. The curvature of CL was assessed using three methods: the C2-C7 Cobb angle (Cobb A), the C2-C7 Harrison posterior tangent angle (Harrison A), and Borden’s method for evaluating CL depth. Measurements of CL curvature were performed using the previously described methodologies by two authors, employing a Picture Archiving and Communication System. The selected participants were categorized into two cohorts: young adults (aged < 40 years) and older adults (aged ≥ 40 years). Results In the 2016 and 2024 cohorts, no significant age differences based on gender were observed. Females in these cohorts exhibited significantly lower CL curvature measurements, as assessed by the Cobb A and CL depth indices, in comparison to their male counterparts. Furthermore, within these cohorts, older adults demonstrated a reduction in CL depth compared to younger adults. The assessment of CL curvature in the 2024 cohort, utilizing the Cobb A and Harrison A methods, revealed a reduction in measurements compared to the 2016 cohort. This decrease was observed across both genders and all age groups. Conclusions The findings of this study indicate a decline in CL curvature over the past eight years. Further research is warranted to investigate the underlying causes and implications of this trend. Cervical lordosis Cervical lordosis curvature C2-C7 Cobb angle Harrison posterior tangent angle Cervical lordosis depth Asymptomatic populations Radiography analysis Figures Figure 1 Introduction Concurrently, advancements in technology have markedly improved personal convenience through electronic devices. Nonetheless, this technological progress has resulted in heightened dependency on these devices. The pervasive use of handheld electronics and mobile phones, notwithstanding their numerous advantages, has elicited concerns. The widespread utilization of mobile phones and their potential health implications, such as myopia and cervical spondylosis, have emerged as significant subjects of scholarly discourse. 1 – 6 A recent community-based cross-sectional study reported a prevalence of cervical spondylosis of 13.76% within the Chinese population. 7 The phenomenon known as "text neck," primarily associated with prolonged mobile phone usage, may contribute to accelerated cervical disc degeneration and cervical kyphosis. 1 This is attributed to the continuous exposure to electronic devices and the sustained forward flexion of the neck, which impose increased biomechanical loads on the cervical spine in progressively flexed postures. 8 Scholars extensively acknowledge the significant correlation between "text neck" and excessive mobile phone usage, identifying "text neck" as an emerging global health epidemic. 9 – 14 Excessive use of mobile phones is increasingly recognized as a potential factor influencing alterations in cervical lordosis (CL) curvature. 6 Simultaneously, modifications in CL curvature within the cervical sagittal balance have been demonstrated to substantially affect cervical spine stability. 15 – 17 Research indicates that changes in cervical sagittal balance are closely associated with cervical degenerative diseases. 18 Consequently, comprehending the trends in CL curvature alterations prompted by technological advancements is essential for enhancing our understanding of their impact on cervical spine health. This study seeks to address a substantial gap in the literature by investigating recent trends in CL curvature over the past eight years, while recognizing the imperative need to assess the influence of technological advancements on CL curvature. Materials and methods Participants This study performed a retrospective analysis on a cohort of healthy individuals of East Asian descent who underwent anteroposterior and lateral digital radiography (DR) of the cervical spine within the medical examination departments of four hospitals. These individuals, who had presented for routine physical examinations, were randomly selected from the existing database. Informed consent was waived for this retrospective analysis. The DR images were acquired in the years 2016 and 2024, respectively. Data collection was facilitated through an internal search of hospital records. Prior to data collection, approval was obtained from the hospital's institutional review board (Approval No. K295-1). Owing to the retrospective design of the study, the requirement for individual patient consent was waived. Exclusion criteria encompassed patients with a history of cervical spine surgery, those under the age of 18, and individuals presenting with scoliotic deformity or cervical spondylolisthesis. Parameters were independently assessed twice by two authors utilizing a Picture Archiving and Communication System (PACS), with the mean value used for further analysis. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. 19 Participants were categorized into two cohorts based on the year of participation: the 2016 cohort and the 2024 cohort. The 2016 cohort included 89 male and 79 female participants, while the 2024 cohort comprised 94 male and 84 female participants. The mean age of male participants in the 2016 cohort was 43.78 years with a standard deviation of 12.14 years, spanning an age range of 22 to 72 years. Female participants in the same cohort had a mean age of 43.18 years with a standard deviation of 11.98 years, and an age range of 24 to 73 years. In the 2024 cohort, the mean age of male participants was 43.65 years with a standard deviation of 13.76 years, within an age range of 23 to 73 years. Female participants in the 2024 cohort had a mean age of 41.64 years with a standard deviation of 13.65 years, and an age range of 21 to 75 years. Participants were stratified into two age-based cohorts: the young adult cohort (Young), which included individuals younger than 40 years, and the older adult cohort (Older), comprising individuals aged 40 years and above. Measurements A consistent radiologic protocol was employed throughout the study duration. Lateral radiographs were acquired with each participant standing in a natural posture, shoulders relaxed, and the auditory-nasal line parallel to the horizontal plane. The hips and knees were fully extended. The radiographs extended to the external occipital convexity, with the X-ray tube centered at the C4 vertebra. In each of the lateral radiographs, the CL angle was assessed using the following methodologies. (Fig. 1 ) C2-C7 Cobb angle measurement method (Cobb A) 20–23 . The angle between the horizontal line of the C2 lower endplate and the horizontal line of the C7 lower endplate. C2–C7 Harrison posterior tangent angle method (Harrison A) 20, 21, 24, 25 . The angle between the line along the posterior margin of the C2 vertebra and the posterior margin of the C7 vertebra. For all angle parameters, lordosis was assigned positive values, while kyphosis was assigned negative values. The CL depth was measured by Borden’s method. 18 , 26 In this method, Line a is delineated by connecting the posterior edges of all vertebral bodies, while Line b extends from the posterior superior margin of the odontoid process to the posterior inferior margin of the C7 vertebra. The CL depth (c) is defined as the maximum perpendicular distance between Line b and Line a. A negative value is recorded when Line b is anterior to Line a. Measurements were independently evaluated by two observers, each of whom performed two separate assessments. The mean of these assessments was recorded. Subsequently, both intra-rater and inter-rater reliability were calculated. Statistical analyses The results are expressed as mean ± standard deviation. Statistical analyses were conducted utilizing SPSS software, version 29.0 (Chicago, IL). The Shapiro-Wilk test was employed to assess the normality of data distribution. Comparisons of measurements based on gender were performed using the independent samples t-test, which was also applied to evaluate differences across various years and age groups. A significance threshold of P < 0.05 was established for all statistical tests. Results No statistically significant age differences were identified between males and females within the 2016 and 2024 cohorts. Furthermore, no significant age differences were detected between participants of the 2016 and 2024 cohorts, irrespective of gender. (Table 1 ) Table 1 Age Comparison 2016 2024 2016 vs. 2024 M F M vs. F M F M vs. F M F n 89 79 94 84 Age (y) 43.78±12.14 43.18±11.98 0.948 43.65±13.76 41.64±13.65 0.448 P = 0.749 P = 0.331 Data are expressed as mean ± standard deviation. M: male, F: female, 2016: data from the year 2016, 2024: data from the year 2024. In the analysis of Cobb A, females exhibited significantly smaller angles compared to males in both the 2016 and 2024 cohorts. This trend was similarly observed for CL depth in both cohorts, as well as for Harrison A in the 2024 cohort, with females displaying significantly smaller measurements than their male counterparts. In the 2024 cohort, both male and female participants exhibited significantly reduced Cobb A and Harrison A measurements compared to the 2016 cohort. (Table 2 ) Table 2 Cervical Lordosis Curvature Across Gender Groups from 2016 to 2024 2016 2024 2016 vs. 2024 M F M vs. F M F M vs. F M F Cobb A (°) 24.20±11.67 20.08±13.43 0.035 19.30±11.70 13.31±11.04 < 0.001 P = 0.005 P < 0.001 Harrison A (°) 25.58±11.60 23.38±13.51 0.257 21.59±11.45 17.03±11.15 0.008 P = 0.020 P = 0.001 CL depth (mm) 10.81±4.98 8.86±4.93 0.012 10.56±6.23 7.81±5.49 0.002 P = 0.772 P = 0.202 Data are expressed as mean ± standard deviation. M: male, F: female, 2016: data from the year 2016, 2024: data from the year 2024, Cobb A: C2-C7 Cobb angle, Harrison A: C2–C7 Harrison posterior tangent angle, CL depth: cervical lordosis depth. In the analysis of CL depth, older adults exhibited significantly smaller measurements than young adults in both the 2016 and 2024 cohorts. In the 2024 cohort, both young and older adult groups demonstrated significantly smaller Cobb A and Harrison A measurements compared to those in the 2016 cohort. (Table 3 ) Table 3 Cervical Lordosis Curvature Across Age Groups from 2016 to 2024 2016 2024 2016 vs. 2024 Young Older Young vs. Older Young Older Young vs. Older Young Older n 63 105 84 94 Cobb A (°) 24.73±13.69 20.78±11.82 0.050 15.87±11.38 17.02±12.11 0.257 P < 0.001 P = 0.028 Harrison A (°) 26.08±13.46 23.63±11.93 0.221 19.17±11.52 19.68±11.56 0.385 P = 0.001 P = 0.019 CL depth (mm) 11.30±5.25 9.05±4.73 0.002 10.28±5.53 8.36±6.34 0.033 P = 0.263 P = 0.381 Data are expressed as mean ± standard deviation. Young: the young adult group (< 40 years), Older: the older adult group (≥ 40 years), 2016: data from the year 2016, 2024: data from the year 2024, Cobb A: C2-C7 Cobb angle, Harrison A: C2–C7 Harrison posterior tangent angle, CL depth: cervical lordosis depth. The intra-rater correlation coefficients for evaluating the CL parameters ranged from 0.87 to 0.95, whereas the interobserver correlation coefficients ranged from 0.85 to 0.94. These values suggest a high degree of measurement reliability, indicating both good to excellent consistency. Discussion The primary objective of this research was to ascertain whether recent lifestyle changes have impacted CL curvature within the population. The findings of the present study confirm that CL curvature measurements are indeed smaller today than they were eight years ago, affecting both males and females across all age groups. Studies have indicated gender differences in cervical spine morphology, consistently finding that females exhibit smaller CL curvature measurements compared to males. 27 – 30 Our study corroborated these findings, demonstrating that the C2-C7 Cobb angles are indeed smaller in females than in males. We hypothesized that the reduced CL curvature in females may be associated with their generally lower levels of outdoor physical activity. Furthermore, our study reinforced the established negative correlation between the C2-C7 Cobb angle and age, 31 indicating that CL depth is significantly diminished in older adults compared to younger individuals. Previous research has demonstrated that individuals exhibit significantly increased cervical spine flexion during smartphone use compared to periods of non-use. 32 , 33 Furthermore, the mechanical load on the spine intensifies with increasing degrees of neck flexion. 8 Consequently, habitual long-term smartphone use may lead to a progressive decrease in CL curvature. Biomechanical studies have indicated that Cobb angles are correlated with various parameters of cervical sagittal alignment. 17 Considering the persistence of contemporary lifestyle habits, it is essential to investigate the impact of alterations in CL on other cervical structures, including intervertebral discs. A longitudinal study with a minimum follow-up period of 10 years has demonstrated that CL significantly affects the progression of degenerative changes in the cervical spine. The study found a markedly higher incidence of posterior disk protrusion progression in individuals lacking CL. 18 Additionally, research conducted by Zhuang L et al., which included a cohort of 2,438 young patients, indicates a potential association between cervical disc degeneration and excessive smartphone use. 4 The dominant hypothesis posits that excessive smartphone usage may lead to a gradual decrease in CL, thereby elevating stress on the intervertebral discs and potentially inducing their degeneration. This process could contribute to a heightened incidence of degenerative cervical spondylosis. However, additional empirical research is necessary to substantiate this relationship. Cuéllar JM et al have posited that "text neck," a condition linked to the contemporary prevalence of smartphone usage, could be considered an epidemic. 1 They emphasized the need for additional clinical research to evaluate whether this condition might expedite the progression of cervical kyphosis. Our research indicated that "text neck" may indeed have the capacity to affect cervical spine curvature. A comprehensive review revealed that the incidence of degenerative cervical spine disorders is increasing worldwide, irrespective of economic status. 34 A population-based study has concurrently demonstrated a 74.1% increase in annual surgical rates for these conditions between 2008 and 2014, underscoring the rising incidence and prevalence. 35 Our study demonstrated that the increasing incidence of degenerative cervical spine diseases may be linked to the progressive reduction in CL curvature. This reduction not only exacerbated the prevalence of degenerative cervical spondylosis but also corresponded with the heightened annual surgical rates. This study acknowledges several limitations. One significant limitation is the relatively small sample size, which may affect the accuracy and reliability of the findings; future research with a larger sample size is anticipated to mitigate this issue. Moreover, the study did not explore other cervical spine tissue changes, such as the extent of intervertebral disc degeneration. Additionally, the scope of the study was constrained by the limited number of research centers involved, as well as regional variations in lifestyle habits and electronic device usage. Conclusions In this study, we demonstrated that individuals currently exhibit a further reduction in CL curvature and deviate more from the ideal cervical alignment compared to data from eight years prior. Future research should investigate the underlying causes of this decline in cervical curvature and examine the potential implications of this trend. Abbreviations CL Cervical Lordosis Cobb A C2-C7 Cobb angle Harrison A C2-C7 Harrison posterior tangent angle DR Digital Radiography PACS Picture Archiving and Communication System STROBE Strengthening the Reporting of Observational Studies in Epidemiology Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University (Approval No. K295-1). The need for informed consent was waived by the Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University because of the retrospective nature of the study. Consent for publication Not applicable. Availability of data and materials All datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no competing interests. Funding This study was supported by the 2022 Joint Funding Scheme for Scientific Research Projects (FDCT-GDST Projects) of the Science and Technology Development Fund of Macau, the Department of Science and Technology of Guangdong Province (2022A0505020019 &0056/2021/AGJ), the Project of the Administration of Traditional Chinese Medicine of Guangdong Province of China (NO. 20241046), and the National Natural Science Foundation of China (NO. 82302035) . Authors' contributions X.L. and W.Z. conceived and designed the study. X.L. and Z.S. performed formal analysis. Z.S., W.Z and P.L. contributed to data acquisition and investigation. X.L. and Z.X. developed the methodology. H.L. and L.Y. supervised the project. X.L. and L.Y. wrote the original draft. L.Y. and H.L. reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript. 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Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACPgYeBoaECgYGNna4WAJ+LWxgLWeADGaStDC2AVnEa5HIPfjh4bxt8nzMDMyfef4cZuBnzzFg+LkDn5a8ZInEbbcN25gZ2KR52w4zSPa8MWDsPYNHC88ZA5AWRpAWZt6GwwwGN3IMmMFOxa3F+EfinNv2bTCH2RPUwt5jJpHYcDsRqIVBmocNaIsEEVosEo7dTm4DKpOc25bOI3HmWcHBXjxa+Jl5jG/+qLltO7+9+fCHN3+s5fjbkzc++IlHCxJgbGACxhEPiHmAKA1gTT+IVjoKRsEoGAUjCQAABFBGsEc89k8AAAAASUVORK5CYII=","orcid":"","institution":"Department of Spine Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Hai","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2025-09-30 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05:42:21","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":219401,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7753732/v1/66ceaf05cc6cb49045b7d1a9.png"},{"id":95504038,"identity":"c06c049f-77f7-4d87-b9dd-30865f54e8d5","added_by":"auto","created_at":"2025-11-10 05:42:21","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76319,"visible":true,"origin":"","legend":"","description":"","filename":"9b2e231cade84c80bc26419567757c4d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7753732/v1/eeaabf4ad991ad11d031bb3b.xml"},{"id":95504039,"identity":"7a753a96-dcec-488a-a5ed-bd416a824189","added_by":"auto","created_at":"2025-11-10 05:42:21","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84000,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7753732/v1/d0fddee320eef6335adc0f86.html"},{"id":95529241,"identity":"9533daaa-256d-4dac-8792-9365417606dc","added_by":"auto","created_at":"2025-11-10 10:16:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":840418,"visible":true,"origin":"","legend":"\u003cp\u003eThree methods used for measuring cervical lordosis curvature in lateral digital radiographic images.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7753732/v1/b8e720508e60ba28b92b2aa7.jpeg"},{"id":102234056,"identity":"05caabf3-ca8c-497e-9c4a-f67324c41124","added_by":"auto","created_at":"2026-02-09 16:05:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1442508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7753732/v1/11bdc036-d390-43ce-a749-55d5aded6986.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Cervical Lordosis Curvature Decline in Chinese Asymptomatic Populations from 2016 to 2024: A Comparative Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eConcurrently, advancements in technology have markedly improved personal convenience through electronic devices. Nonetheless, this technological progress has resulted in heightened dependency on these devices. The pervasive use of handheld electronics and mobile phones, notwithstanding their numerous advantages, has elicited concerns. The widespread utilization of mobile phones and their potential health implications, such as myopia and cervical spondylosis, have emerged as significant subjects of scholarly discourse.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA recent community-based cross-sectional study reported a prevalence of cervical spondylosis of 13.76% within the Chinese population.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e The phenomenon known as \"text neck,\" primarily associated with prolonged mobile phone usage, may contribute to accelerated cervical disc degeneration and cervical kyphosis.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e This is attributed to the continuous exposure to electronic devices and the sustained forward flexion of the neck, which impose increased biomechanical loads on the cervical spine in progressively flexed postures.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Scholars extensively acknowledge the significant correlation between \"text neck\" and excessive mobile phone usage, identifying \"text neck\" as an emerging global health epidemic.\u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eExcessive use of mobile phones is increasingly recognized as a potential factor influencing alterations in cervical lordosis (CL) curvature.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Simultaneously, modifications in CL curvature within the cervical sagittal balance have been demonstrated to substantially affect cervical spine stability.\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Research indicates that changes in cervical sagittal balance are closely associated with cervical degenerative diseases.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Consequently, comprehending the trends in CL curvature alterations prompted by technological advancements is essential for enhancing our understanding of their impact on cervical spine health.\u003c/p\u003e\u003cp\u003eThis study seeks to address a substantial gap in the literature by investigating recent trends in CL curvature over the past eight years, while recognizing the imperative need to assess the influence of technological advancements on CL curvature.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThis study performed a retrospective analysis on a cohort of healthy individuals of East Asian descent who underwent anteroposterior and lateral digital radiography (DR) of the cervical spine within the medical examination departments of four hospitals. These individuals, who had presented for routine physical examinations, were randomly selected from the existing database. Informed consent was waived for this retrospective analysis. The DR images were acquired in the years 2016 and 2024, respectively. Data collection was facilitated through an internal search of hospital records. Prior to data collection, approval was obtained from the hospital's institutional review board (Approval No. K295-1). Owing to the retrospective design of the study, the requirement for individual patient consent was waived. Exclusion criteria encompassed patients with a history of cervical spine surgery, those under the age of 18, and individuals presenting with scoliotic deformity or cervical spondylolisthesis. Parameters were independently assessed twice by two authors utilizing a Picture Archiving and Communication System (PACS), with the mean value used for further analysis. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eParticipants were categorized into two cohorts based on the year of participation: the 2016 cohort and the 2024 cohort. The 2016 cohort included 89 male and 79 female participants, while the 2024 cohort comprised 94 male and 84 female participants. The mean age of male participants in the 2016 cohort was 43.78 years with a standard deviation of 12.14 years, spanning an age range of 22 to 72 years. Female participants in the same cohort had a mean age of 43.18 years with a standard deviation of 11.98 years, and an age range of 24 to 73 years. In the 2024 cohort, the mean age of male participants was 43.65 years with a standard deviation of 13.76 years, within an age range of 23 to 73 years. Female participants in the 2024 cohort had a mean age of 41.64 years with a standard deviation of 13.65 years, and an age range of 21 to 75 years.\u003c/p\u003e\u003cp\u003eParticipants were stratified into two age-based cohorts: the young adult cohort (Young), which included individuals younger than 40 years, and the older adult cohort (Older), comprising individuals aged 40 years and above.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eA consistent radiologic protocol was employed throughout the study duration. Lateral radiographs were acquired with each participant standing in a natural posture, shoulders relaxed, and the auditory-nasal line parallel to the horizontal plane. The hips and knees were fully extended. The radiographs extended to the external occipital convexity, with the X-ray tube centered at the C4 vertebra.\u003c/p\u003e\u003cp\u003eIn each of the lateral radiographs, the CL angle was assessed using the following methodologies. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eC2-C7 Cobb angle measurement method (Cobb A)\u003csup\u003e20\u0026ndash;23\u003c/sup\u003e. The angle between the horizontal line of the C2 lower endplate and the horizontal line of the C7 lower endplate.\u003c/p\u003e\u003cp\u003eC2\u0026ndash;C7 Harrison posterior tangent angle method (Harrison A)\u003csup\u003e20, 21, 24, 25\u003c/sup\u003e. The angle between the line along the posterior margin of the C2 vertebra and the posterior margin of the C7 vertebra.\u003c/p\u003e\u003cp\u003eFor all angle parameters, lordosis was assigned positive values, while kyphosis was assigned negative values.\u003c/p\u003e\u003cp\u003eThe CL depth was measured by Borden\u0026rsquo;s method.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e In this method, Line a is delineated by connecting the posterior edges of all vertebral bodies, while Line b extends from the posterior superior margin of the odontoid process to the posterior inferior margin of the C7 vertebra. The CL depth (c) is defined as the maximum perpendicular distance between Line b and Line a. A negative value is recorded when Line b is anterior to Line a.\u003c/p\u003e\u003cp\u003eMeasurements were independently evaluated by two observers, each of whom performed two separate assessments. The mean of these assessments was recorded. Subsequently, both intra-rater and inter-rater reliability were calculated.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eThe results are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Statistical analyses were conducted utilizing SPSS software, version 29.0 (Chicago, IL). The Shapiro-Wilk test was employed to assess the normality of data distribution. Comparisons of measurements based on gender were performed using the independent samples t-test, which was also applied to evaluate differences across various years and age groups. A significance threshold of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was established for all statistical tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eNo statistically significant age differences were identified between males and females within the 2016 and 2024 cohorts. Furthermore, no significant age differences were detected between participants of the 2016 and 2024 cohorts, irrespective of gender. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge Comparison\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e2016 vs. 2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eM vs. F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eM vs. F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.78\u0026plusmn;12.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.18\u0026plusmn;11.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.948\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.65\u0026plusmn;13.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.64\u0026plusmn;13.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.749\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. M: male, F: female, 2016: data from the year 2016, 2024: data from the year 2024.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the analysis of Cobb A, females exhibited significantly smaller angles compared to males in both the 2016 and 2024 cohorts. This trend was similarly observed for CL depth in both cohorts, as well as for Harrison A in the 2024 cohort, with females displaying significantly smaller measurements than their male counterparts. In the 2024 cohort, both male and female participants exhibited significantly reduced Cobb A and Harrison A measurements compared to the 2016 cohort. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCervical Lordosis Curvature Across Gender Groups from 2016 to 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e2016 vs. 2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eM vs. F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eM vs. F\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCobb A (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.20\u0026plusmn;11.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.08\u0026plusmn;13.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.30\u0026plusmn;11.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.31\u0026plusmn;11.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHarrison A (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.58\u0026plusmn;11.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.38\u0026plusmn;13.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.59\u0026plusmn;11.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.03\u0026plusmn;11.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCL depth (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.81\u0026plusmn;4.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.86\u0026plusmn;4.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.56\u0026plusmn;6.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.81\u0026plusmn;5.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. M: male, F: female, 2016: data from the year 2016, 2024: data from the year 2024, Cobb A: C2-C7 Cobb angle, Harrison A: C2\u0026ndash;C7 Harrison posterior tangent angle, CL depth: cervical lordosis depth.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the analysis of CL depth, older adults exhibited significantly smaller measurements than young adults in both the 2016 and 2024 cohorts. In the 2024 cohort, both young and older adult groups demonstrated significantly smaller Cobb A and Harrison A measurements compared to those in the 2016 cohort. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCervical Lordosis Curvature Across Age Groups from 2016 to 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e2016 vs. 2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYoung\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eOlder\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eYoung vs. Older\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eYoung\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eOlder\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eYoung vs. Older\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eYoung\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eOlder\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCobb A (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.73\u0026plusmn;13.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.78\u0026plusmn;11.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.87\u0026plusmn;11.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.02\u0026plusmn;12.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHarrison A (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.08\u0026plusmn;13.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.63\u0026plusmn;11.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.17\u0026plusmn;11.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.68\u0026plusmn;11.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCL depth (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.30\u0026plusmn;5.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.05\u0026plusmn;4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.28\u0026plusmn;5.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.36\u0026plusmn;6.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.381\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Young: the young adult group (\u0026lt;\u0026thinsp;40 years), Older: the older adult group (\u0026ge;\u0026thinsp;40 years), 2016: data from the year 2016, 2024: data from the year 2024, Cobb A: C2-C7 Cobb angle, Harrison A: C2\u0026ndash;C7 Harrison posterior tangent angle, CL depth: cervical lordosis depth.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe intra-rater correlation coefficients for evaluating the CL parameters ranged from 0.87 to 0.95, whereas the interobserver correlation coefficients ranged from 0.85 to 0.94. These values suggest a high degree of measurement reliability, indicating both good to excellent consistency.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary objective of this research was to ascertain whether recent lifestyle changes have impacted CL curvature within the population. The findings of the present study confirm that CL curvature measurements are indeed smaller today than they were eight years ago, affecting both males and females across all age groups.\u003c/p\u003e\u003cp\u003eStudies have indicated gender differences in cervical spine morphology, consistently finding that females exhibit smaller CL curvature measurements compared to males.\u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Our study corroborated these findings, demonstrating that the C2-C7 Cobb angles are indeed smaller in females than in males. We hypothesized that the reduced CL curvature in females may be associated with their generally lower levels of outdoor physical activity. Furthermore, our study reinforced the established negative correlation between the C2-C7 Cobb angle and age,\u003csup\u003e31\u003c/sup\u003e indicating that CL depth is significantly diminished in older adults compared to younger individuals.\u003c/p\u003e\u003cp\u003ePrevious research has demonstrated that individuals exhibit significantly increased cervical spine flexion during smartphone use compared to periods of non-use.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Furthermore, the mechanical load on the spine intensifies with increasing degrees of neck flexion.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Consequently, habitual long-term smartphone use may lead to a progressive decrease in CL curvature. Biomechanical studies have indicated that Cobb angles are correlated with various parameters of cervical sagittal alignment.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Considering the persistence of contemporary lifestyle habits, it is essential to investigate the impact of alterations in CL on other cervical structures, including intervertebral discs.\u003c/p\u003e\u003cp\u003eA longitudinal study with a minimum follow-up period of 10 years has demonstrated that CL significantly affects the progression of degenerative changes in the cervical spine. The study found a markedly higher incidence of posterior disk protrusion progression in individuals lacking CL.\u003csup\u003e18\u003c/sup\u003e Additionally, research conducted by Zhuang L et al., which included a cohort of 2,438 young patients, indicates a potential association between cervical disc degeneration and excessive smartphone use.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The dominant hypothesis posits that excessive smartphone usage may lead to a gradual decrease in CL, thereby elevating stress on the intervertebral discs and potentially inducing their degeneration. This process could contribute to a heightened incidence of degenerative cervical spondylosis. However, additional empirical research is necessary to substantiate this relationship.\u003c/p\u003e\u003cp\u003eCu\u0026eacute;llar JM et al have posited that \"text neck,\" a condition linked to the contemporary prevalence of smartphone usage, could be considered an epidemic.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e They emphasized the need for additional clinical research to evaluate whether this condition might expedite the progression of cervical kyphosis. Our research indicated that \"text neck\" may indeed have the capacity to affect cervical spine curvature. A comprehensive review revealed that the incidence of degenerative cervical spine disorders is increasing worldwide, irrespective of economic status.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e A population-based study has concurrently demonstrated a 74.1% increase in annual surgical rates for these conditions between 2008 and 2014, underscoring the rising incidence and prevalence.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Our study demonstrated that the increasing incidence of degenerative cervical spine diseases may be linked to the progressive reduction in CL curvature. This reduction not only exacerbated the prevalence of degenerative cervical spondylosis but also corresponded with the heightened annual surgical rates.\u003c/p\u003e\u003cp\u003eThis study acknowledges several limitations. One significant limitation is the relatively small sample size, which may affect the accuracy and reliability of the findings; future research with a larger sample size is anticipated to mitigate this issue. Moreover, the study did not explore other cervical spine tissue changes, such as the extent of intervertebral disc degeneration. Additionally, the scope of the study was constrained by the limited number of research centers involved, as well as regional variations in lifestyle habits and electronic device usage.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we demonstrated that individuals currently exhibit a further reduction in CL curvature and deviate more from the ideal cervical alignment compared to data from eight years prior. Future research should investigate the underlying causes of this decline in cervical curvature and examine the potential implications of this trend.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCervical Lordosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCobb A\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC2-C7 Cobb angle\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHarrison A\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC2-C7 Harrison posterior tangent angle\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDigital Radiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePACS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePicture Archiving and Communication System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSTROBE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University (Approval No. K295-1). The need for informed consent was waived by the Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University because of the retrospective nature of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the 2022 Joint Funding Scheme for Scientific Research Projects (FDCT-GDST Projects) of the Science and Technology Development Fund of Macau, the Department of Science and Technology of Guangdong Province (2022A0505020019 \u0026amp;0056/2021/AGJ), the Project of the Administration of Traditional Chinese Medicine of Guangdong Province of China (NO. 20241046), and the National Natural Science Foundation of China (NO. 82302035)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX.L. and W.Z. conceived and designed the study. X.L. and Z.S. performed formal analysis. Z.S., W.Z and P.L. contributed to data acquisition and investigation. X.L. and Z.X. developed the methodology. H.L. and L.Y. supervised the project. X.L. and L.Y. wrote the original draft. L.Y. and H.L. reviewed and edited the manuscript. All authors reviewed and approved the final version of the manuscript. X.L., W.Z., Z.S. and Y.B. contributed equally to this work and share first authorship. L.Y. and H.L. contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCu\u0026eacute;llar JM, Lanman TH. Text neck: an epidemic of the modern era of cell phones? Spine J. 2017;17:901\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTricard D, Marillet S, Ingrand P et al. Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol 2021:2020\u0026ndash;318256.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWarda DG, Nwakibu U, Nourbakhsh A. Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents. Healthcare. 2023;11:819.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhuang L, Wang L, Xu D, et al. Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. J Orthop Sci. 2021;26:110\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCevik S, Kaplan A, Katar S. Correlation of Cervical Spinal Degeneration with Rise in Smartphone Usage Time in Young Adults. Niger J Clin Pract. 2020;23:1748.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;ğrenci A, Koban O, Yaman O, et al. The Effect of Technological Devices on Cervical Lordosis. Open Access Macedonian J Med Sci. 2018;6:467\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLv Y, Tian W, Chen D et al. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults: a community-based cross-sectional study. BMC Musculoskelet Disord 2018;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014;25:277\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrasser T, Borges Dario A, Parreira PCS, et al. Defining text neck: a scoping review. Eur Spine J. 2023;32:3463\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDerakhshanrad N, Yekaninejad MS, Mehrdad R, et al. Neck pain associated with smartphone overuse: cross-sectional report of a cohort study among office workers. Eur Spine J. 2021;30:461\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSirajudeen MS, Alzhrani M, Alanazi A, et al. Prevalence of text neck posture, smartphone addiction, and its association with neck disorders among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic. PeerJ. 2022;10:e14443.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFiebert I, Kistner F, Gissendanner C, et al. Text neck: an adverse postural phenomenon. WORK-a J Prev Assess Rehabilitation. 2021;69:1261\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalameh MA, Boyajian SD, Amaireh EA, et al. Prevalence of text neck syndrome, its impact on neck dysfunction, and its associated factors among medical students: a cross-sectional study. WORK-a J Prev Assess Rehabilitation. 2024;79:1111\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRossella Bottaro PF. The Association Between Upper Disorders and Psychological Well-Being and its Implication in Text Neck Syndrome: a Systematic Review. Clin Neuropsychiatry. 2022;19:280\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee SH, Hyun S, Jain A. Cervical Sagittal Alignment: Literature Review and Future Directions. Neurospine. 2020;17:478\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatwardhan AG, Khayatzadeh S, Havey RM, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J. 2018;27:25\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatwardhan AG, Havey RM, Khayatzadeh S, et al. Postural Consequences of Cervical Sagittal Imbalance. Spine. 2015;40:783\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu-hui Z, Jia-hu F, Lian-shun J, et al. Clinical significance of cervical vertebral flexion and extension spatial alignment changes. Spine. 2009;34:E21\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13:31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarrison DEHDCR. Cobb Method or Harrison Posterior Tangent Method. Spine. 2000;25:2072\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJanusz P, Tyrakowski M, Yu H, et al. Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur Spine J. 2016;25:3596\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorteza Faghih Jouibari JCLH. Comparison of cervical sagittal parameters among patients with neck pain and healthy controls: a comparative cross \u0026ndash; sectional study. Eur Spine J. 2019;28:2319\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJin L, Liang Y, Guo C, et al. Cervical Sagittal Alignment and Balance Associated with Aging Chinese Adults: a Radiographic Analysis. Global Spine J. 2024;14:2232\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGore DR. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986;11:521\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlijani B, Rasoulian J. The Sagittal Balance of the Cervical Spine: Radiographic Analysis of Interdependence between the Occipitocervical and Spinopelvic Alignment. Asian Spine J. 2020;14:287\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBORDEN AG, RECHTMAN AM, GERSHON-COHEN J. The normal cervical lordosis. Radiology. 1960;74:806\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu Y, Zhang X, Fan Y et al. Sagittal alignment of the cervical spine: radiographic analysis of 111 asymptomatic adolescents, a retrospective observational study. BMC Musculoskelet Disord 2022;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang Y, Zhao W, Liu X, et al. Normative values of cervical sagittal alignment according to global spine balance: based on 126 asymptomatic Chinese young adults. Eur Spine J. 2021;30:2427\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInoue T, Ito K, Ando K, et al. Age-related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic individuals. Eur Spine J. 2020;29:2378\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo G, Li J, Diao Q et al. Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res 2018;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIyer S, Nemani VM, Nguyen J, et al. Impact of Cervical Sagittal Alignment Parameters on Neck Disability. Spine. 2016;41:371\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzeto GPY, Tsang SMH, Dai J, et al. A field study on spinal postures and postural variations during smartphone use among university students. Appl Ergon. 2020;88:103183.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics. 2015;58:220\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaheed MA, Hasan S, Tan LA, et al. Cervical spine pathology and treatment: a global overview. J Spine Surg. 2020;6:340\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKristiansen J, Balteskard L, Sletteb\u0026oslash; H, et al. The use of surgery for cervical degenerative disease in Norway in the period 2008\u0026ndash;2014. Acta Neurochir. 2016;158:969\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical lordosis, Cervical lordosis curvature, C2-C7 Cobb angle, Harrison posterior tangent angle, Cervical lordosis depth, Asymptomatic populations, Radiography analysis","lastPublishedDoi":"10.21203/rs.3.rs-7753732/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7753732/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith the widespread increase in the use of electronic devices, there has been a growing concern regarding their potential impact on health, particularly concerning the cervical spine. The overuse of mobile phones has been associated with cervical spondylosis and other cervical spine disorders. This study sought to assess recent trends in cervical lordosis (CL) curvature over the past eight years.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAsymptomatic individuals who underwent cervical spine radiography at four hospitals were randomly selected from hospital databases for a comparative analysis of data spanning from 2016 to 2024. The curvature of CL was assessed using three methods: the C2-C7 Cobb angle (Cobb A), the C2-C7 Harrison posterior tangent angle (Harrison A), and Borden\u0026rsquo;s method for evaluating CL depth. Measurements of CL curvature were performed using the previously described methodologies by two authors, employing a Picture Archiving and Communication System. The selected participants were categorized into two cohorts: young adults (aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years) and older adults (aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn the 2016 and 2024 cohorts, no significant age differences based on gender were observed. Females in these cohorts exhibited significantly lower CL curvature measurements, as assessed by the Cobb A and CL depth indices, in comparison to their male counterparts. Furthermore, within these cohorts, older adults demonstrated a reduction in CL depth compared to younger adults. The assessment of CL curvature in the 2024 cohort, utilizing the Cobb A and Harrison A methods, revealed a reduction in measurements compared to the 2016 cohort. This decrease was observed across both genders and all age groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe findings of this study indicate a decline in CL curvature over the past eight years. Further research is warranted to investigate the underlying causes and implications of this trend.\u003c/p\u003e","manuscriptTitle":"A Cervical Lordosis Curvature Decline in Chinese Asymptomatic Populations from 2016 to 2024: A Comparative Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:42:16","doi":"10.21203/rs.3.rs-7753732/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T08:59:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T06:38:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T15:30:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T04:44:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1375496188403203102311255030074318378","date":"2025-11-11T23:01:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221436766951438063501447807890703976539","date":"2025-11-11T22:53:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52351088407305823119796476826295807052","date":"2025-11-11T22:50:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T06:09:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T05:38:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-27T18:25:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-25T14:33:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-10-25T14:30:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6a97433-3c1b-4679-a33b-522cdff05198","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:01:47+00:00","versionOfRecord":{"articleIdentity":"rs-7753732","link":"https://doi.org/10.1186/s12891-026-09510-9","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2026-02-02 15:58:18","publishedOnDateReadable":"February 2nd, 2026"},"versionCreatedAt":"2025-11-10 05:42:16","video":"","vorDoi":"10.1186/s12891-026-09510-9","vorDoiUrl":"https://doi.org/10.1186/s12891-026-09510-9","workflowStages":[]},"version":"v1","identity":"rs-7753732","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7753732","identity":"rs-7753732","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}