{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:50:00Z","timestamp":1747187400138,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Focal cervical kyphotic deformity (FCK) without neurologic compression is not uncommon in patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical decompression and fusion (ACDF) surgery. It remains unclear whether FCK at non\u2010responsible levels needs to be treated simultaneously. This study aims to investigate whether FCK at non\u2010responsible levels is the prognostic factor for CSM and elucidate the surgical indication for FCK.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with CSM who underwent ACDF between January 2016 and April 2021 were included. Patients were divided into two groups according to the presence of FCK and two classifications according to global cervical sagittal alignment. Clinical outcomes were compared using Japanese Orthopaedic Association (JOA) scores and recovery rate (RR) of neurologic function. Univariate and multivariate analysis based on RR assessed the relationship between various possible prognostic factors and clinical outcomes. The receiver operating characteristic curve (ROC) was used to determine the optimal cutoff value of the focal Cobb angle to predict poor clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 94 patients were included, 41 with FCK and 53 without. Overall, the RR of neurologic function was significantly lower in the FCK than in the non\u2010FCK group. Further analysis showed that the RR difference between the two groups was only observed in hypo\u2010lordosis classification (kyphotic and sigmoid alignment), but not in the lordosis classification. Multivariate analysis showed that the preoperative focal Cobb angle in the FCK level (OR\u2009=\u20090.42; 95% CI\u2009=\u20090.18\u20130.97) was independently associated with clinical outcomes in the hypo\u2010lordosis classification. The optimal cutoff point of the preoperative focal kyphotic Cobb angle was calculated at 4.05\u00b0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For CSM with hypo\u2010lordosis, FCK was a risk factor for poor postoperative outcomes. Surgeons may consider treating the FCK simultaneously if the focal kyphotic Cobb angle of FCK is greater than 4.05\u00b0 and is accompanied by cervical global kyphotic or sigmoid deformity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14048","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T06:15:05Z","timestamp":1715148905000},"page":"1407-1417","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Focal Kyphotic Deformity at Non\u2010responsible Levels Affect the Outcomes of Anterior Cervical Decompression and Fusion?"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7441-3129","authenticated-orcid":false,"given":"Jia","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Spine Center, Changzheng Hospital Naval Military Medical University (Second Military Medical University)  Shanghai People's Republic of 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