{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:55:21Z","timestamp":1788501321591,"version":"build-2803163510"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T00:00:00Z","timestamp":1522281600000},"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":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGOUND<\/jats:title>\n                    <jats:p>Recently, previous research proposed a cervical spine deformity (CSD) classification using a modified Delphi approach. However, C2-C7 sagittal vertical axis (SVA) and T1 slope minus C2-C7 lordosis (TS\u2212CL) cut-off values for moderate and severe disability were based on expert opinion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate the validity of a CSD classification system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>From 2007 to 2012, 30 consecutive patients with a minimum 5-yr follow-up having 3- or more level posterior cervical fusion met inclusion criteria. The following radiographic parameters were measured: C0-C2 lordosis, C2-C7 lordosis, C2-C7 SVA, T1 slope, and TS\u2212CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and health-related quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Average follow-up period was 7.3 yr. C2-C7 SVA positively correlated with neck disability index (NDI) scores (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.554). Regression models predicted a threshold C2-C7 SVA value of 40.8 mm and 70.6 mm correlated with moderate and severe disability based on the NDI score, respectively. The TS\u2212CL had positive correlation with C2-C7 SVA and NDI scores (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.841 and\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.625, respectively). Regression analyses revealed that a C2-C7 SVA value of 40 mm and 70 mm corresponded to a TS\u2212CL value of 20\u00b0 and 25\u00b0, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Regression models predicted a threshold C2-C7 SVA (value of 40.8 mm and 70.6 mm) and TS\u2212CL (value of 20\u00b0 and 25\u00b0) correlated with moderate and severe disability based on the NDI, respectively. The cut-off value C2-C7 SVA and TS\u2212CL modifier of the CSD classification can be revised accordingly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy055","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T04:06:33Z","timestamp":1522296393000},"page":"20-26","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":37,"title":["Assessment of T1 Slope Minus Cervical Lordosis and C2-7 Sagittal Vertical Axis Criteria of a Cervical Spine Deformity Classification System Using Long-Term Follow-up Data After Multilevel Posterior Cervical Fusion Surgery"],"prefix":"10.1227","volume":"16","author":[{"given":"Seung-Jae","family":"Hyun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanghyun","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Jeong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Ahn","family":"Jahng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Jib","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,1]]},"reference":[{"issue":"6","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"673","DOI":"10.3171\/2014.12.SPINE14780","article-title":"Reliability assessment of a novel cervical spine deformity classification system","volume":"23","author":"Ames","year":"2015","journal-title":"J Neurosurg Spine"},{"issue":"7","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"E396","DOI":"10.1097\/BRS.0000000000001264","article-title":"Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis","volume":"41","author":"Hyun","year":"2016","journal-title":"Spine"},{"issue":"3","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1227\/NEU.0b013e31826100c9","article-title":"The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery","volume":"71","author":"Tang","year":"2012","journal-title":"Neurosurgery"},{"issue":"7","key":"bib4-20240909","first-page":"409","article-title":"The Neck Disability Index: a study of reliability and validity","volume":"14","author":"Vernon","year":"1991","journal-title":"J Manipulative Physiol Ther"},{"issue":"13","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1097\/00007632-199707010-00009","article-title":"Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms","volume":"22","author":"Hardacker","year":"1997","journal-title":"Spine"},{"key":"bib6-20240909","article-title":"Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment","author":"Lee","year":"2013","journal-title":"Spine 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osteotomy","volume":"37","author":"Lafage","year":"2012","journal-title":"Spine"},{"issue":"10","key":"bib10-20240909","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1097\/BRS.0b013e31823b0892","article-title":"Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy","volume":"37","author":"Smith","year":"2012","journal-title":"Spine"},{"issue":"4","key":"bib11-20240909","doi-asserted-by":"crossref","first-page":"300","DOI":"10.3171\/2012.6.SPINE1250","article-title":"Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy","volume":"17","author":"Smith","year":"2012","journal-title":"J Neurosurg Spine"},{"issue":"3S","key":"bib12-20240909","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1093\/neuros\/nyw048","article-title":"Recent and emerging advances in spinal 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Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01787389-201901000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:52:07Z","timestamp":1786121527000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01787389-201901000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,29]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opy055","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,29]]},"assertion":[{"value":"2017-10-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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