{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:52:44Z","timestamp":1786125164045,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,8,5]],"date-time":"2017-08-05T00:00:00Z","timestamp":1501891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Primary cervical deformity driver\/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic. Patients were evaluated if surgery included PD apex, based on the lowest instrumented vertebra (LIV): CS: LIV \u2264 C7, CTJ: LIV \u2264 T3, TH: LIV \u2264 T12. Cervical and thoracolumbar alignment was measured preoperatively and 3 mo (3M) postoperatively. PD groups were compared with analysis of variance\/Pearson \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      , paired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Eighty-four ACD patients met inclusion criteria. Thoracic drivers (n = 26) showed greatest preoperative cervical and global malalignment against other PD: higher thoracic kyphosis, pelvic incidence-lumbar lordosis (PI-LL), T1 slope C2-T3 sagittal vertical axis (SVA), and C0-2 angle (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). Differences in baseline-3M alignment changes were observed between surgical PD groups, in PI-LL, LL, T1 slope minus cervical lordosis (TS-CL), cervical SVA, C2-T3 SVA (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). Main changes were between TH and CS driver groups: TH patients had greater PI-LL (4.47\u00b0 vs \u22120.87\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .049), TS-CL (\u221219.12\u00b0 vs \u22124.30,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .050), C2-C7 SVA (\u221218.12 vs \u22124.30 mm,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007), and C2-T3 SVA (\u221224.76 vs 8.50 mm,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002) baseline-3M correction. CTJ drivers trended toward greater LL correction compared to CS drivers (\u22126.00\u00b0 vs 0.88\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .050). Patients operated at CS driver level had a difference in the prevalence of 3M TS-CL modifier grades (0 = 35.7%, 1 = 0.0%, 2 = 13.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .030). There was a significant difference in 3M chin-brow vertical angle modifier grade distribution in TH drivers (0 = 0.0%, 1 = 35.9%, 2 = 14.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .049).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Characterizing ACD patients by PD type reveals differences in pre- and postoperative alignment. Evaluating surgical alignment outcomes based on PD inclusion is important in understanding alignment goals for ACD correction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx438","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T23:11:30Z","timestamp":1500073890000},"page":"651-659","source":"Crossref","is-referenced-by-count":25,"title":["Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment"],"prefix":"10.1227","volume":"83","author":[{"given":"Peter G","family":"Passias","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus M","family":"Jalai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Joint 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Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha R","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W","family":"Poorman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, 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