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Eligible cases were retrieved from the PANDA Registry. Records were excluded if standing X-ray was unavailable and\/or not-evaluable (e.g. shoulder prosthesis); or if the admission pathology involved the cranio-cervical junction, tumors, deformities, spinal cord disease, or infections. Preoperative data included demographic, clinical (VAS neck), psychological (SCL-27, I-TIPI, CD-RISC10), and sagittal balance variables (McGregor slope, C1\u2013C2 lordosis, C2 slope, C2\u2013C7 lordosis, cSVA, T1 slope, cervical mismatch). Correction for multiple comparisons was applied within pre-specified hypothesis domains.<\/jats:p>\n                  <jats:p>Results one-hundred-thirty records were included. Intra-rater reliability for radiographic parameters was excellent (&gt;\u20090.9). After categorization of patients by neck pain severity, pairwise analysis showed that only C1\u2013C2 lordosis remained significantly higher in patients exhibiting severe neck pain (VAS\u2009&lt;\u20097 vs. VAS\u2009\u2265\u20097). When stratified for moderate-to-severe neck pain (VAS\u2009\u2265\u20094), several SCL-27 scales, namely dysthymic, vegetative, agoraphobic, sociophobic, and GSI scores, and C1C2 lordosis showed significant differences. Correlation analysis using VAS neck as the dependent variable demonstrated a significant positive correlation with SCL-27 dysthymic and vegetative scores. C1\u2013C2 lordosis showed a significant inverse correlation with neck pain. In univariate analysis, only SCL-27 dysthymic, vegetative, and GSI scores emerged as significant univariate associations of VAS neck. After correction for multiple comparisons, the SCL-27 vegetative, dysthymic and GSI scores retained significance, whereas C1\u2013C2 lordosis did not.<\/jats:p>\n                  <jats:p>Conclusion in a non-deformity population, sagittal balance parameters alone do not adequately explain patient-perceived neck pain. These findings support the preoperative use of psychological assessments, especially the SCL-27, as a useful tool in preoperative screening and individualised counselling.<\/jats:p>","DOI":"10.1007\/s10143-026-04527-z","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:06:57Z","timestamp":1792364817000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A comprehensive analysis of the association of psychological profiling and sagittal balance parameters with neck pain in a non-deformity cervical spondylosis population: A prospective two-centers cross-sectional study"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5784-5870","authenticated-orcid":false,"given":"Marco","family":"Battistelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Vannuccini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Benenati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Muselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Montano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Visocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Capo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Brembilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Fornari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Gaudino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Doglietto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Maria","family":"Polli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Pia Rosaria","family":"Chieffo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"4527_CR1","doi-asserted-by":"publisher","first-page":"673","DOI":"10.3171\/2014.12.SPINE14780","volume":"23","author":"CP Ames","year":"2015","unstructured":"Ames CP, Smith JS, Eastlack R, Blaskiewicz DJ, Shaffrey CI, Schwab F, Bess S, Kim HJ, Mundis GM, Klineberg E, Gupta M, O\u2019Brien M, Hostin R, Scheer JK, Protopsaltis TS, Fu K-MG, Hart R, Albert TJ, Riew KD, Fehlings MG, Deviren V, Lafage V, __ (2015) Reliability assessment of a novel cervical spine deformity classification system. 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