{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:38:50Z","timestamp":1784162330535,"version":"3.55.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Surgical corrections for adult spinal deformity (ASD) often extend from T4-pelvis. Certain patients may require fusion from C2-pelvis. Comparisons are necessary to guide surgical decision-making, particularly for frailer patients with multiple comorbidities. This study analyzed the additional morbidity incurred by proceeding with fusion to the upper cervical spine (i.e., C2) versus to T4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective analysis comparing C2-pelvis versus T4-pelvis fusions for ASD. Patients were propensity-matched in a 1:4 ratio based on age, sex, ASA score, BMI, smoking, diabetes, and use of 3-column osteotomy. Outcomes included postoperative complications, hospital\/ICU length-of-stay (LOS), time-to-ambulation, 30- and 90-day readmission rates, reoperations, and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      80 patients (16 C2-pelvis, 64 T4-pelvis) were analyzed. All patients had ASA scores\u2009\u2265\u20093. C2-pelvis yielded higher complication rates (100% C2-pelvis vs. 68.7% T4-pelvis; p\u2009=\u20090.008) and number of complications per patient (3.2\u2009\u00b1\u20092.2 C2-pelvis vs. 1.3\u2009\u00b1\u20091.6 T4-pelvis;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). For specific complications, C2-pelvis more often yielded prolonged hypotension requiring vasopressors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), psychiatric complications (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), and delirium (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Hospital LOS was similar between cohorts (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.33), but ICU LOS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and time-to-ambulation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046) were longer after C2-pelvis. C2-pelvis had higher readmission rates within 30 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and 90 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) days. OS was shorter after C2-pelvis (24.4\u2009\u00b1\u20092.8\u00a0months vs. 68.5\u2009\u00b1\u20094.2\u00a0months for T4-pelvis;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>C2-pelvis fusions for ASD yield significantly higher rates\/numbers of complications, longer ICU LOS, longer time-to-ambulation, higher readmission rates, and shorter OS than T4-pelvis fusions, even among patients of similar age and systemic disease\/comorbidities. Greater follow-up and numbers of C2-pelvis patients are required for more definitive outcome comparisons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01490-z","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T17:35:56Z","timestamp":1781976956000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative morbidity and outcomes for adult spinal deformity corrections spanning C2-pelvis compared to T4-pelvis: a propensity score-matched analysis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-1166","authenticated-orcid":false,"given":"Alexander T.","family":"Yahanda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim T.","family":"Bui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Pallotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Neuman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob K.","family":"Greenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hafez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Z.","family":"Ray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo A.","family":"Molina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"1490_CR1","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1007\/S00586-019-06083-1\/FIGURES\/22","volume":"28","author":"JC Le Huec","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A (2019) Sagittal balance of the spine. 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