{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T04:31:41Z","timestamp":1772512301545,"version":"3.50.1"},"reference-count":54,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Advances in Orthopedics"],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. Despite the research progress in the thoraco-lumbo-pelvic balance, cervical spine balance has only recently gained increasing interest. To our knowledge, there is a lack of research regarding sagittal occipitocervical spine balance restoration following posterior occipitocervical fusion (POCF).<jats:italic>Purpose<\/jats:italic>. The primary outcome measure is the evaluation of sagittal cervical alignment roentgenographic parameters and the secondary is the functional outcome (NDI), following POCF for upper (C1 &amp; C2) cervical trauma (UCT) in coexistence with upper cervical spine degeneration.<jats:italic>Patients and Methods<\/jats:italic>. Twenty old and elderly patients aged 62\u2009\u00b1\u200912 years with evident upper cervical degeneration, who received POCF for upper C1 &amp; C2 unstable cervical spine injuries, were included. C2-C7 lordosis, C2-C7 SVA, spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle (TIA), cervical tilt (CT), cranial tilt (CrT), and C0-C1 angle were measured. The subfusion angle was used to study the behavior of the unfused cervical segments below fusion. The Neck Disability Index (NDI) was used for the functional outcome evaluation. 29 age-matched individuals were used as controls for radiographic analysis and self-reported functional status comparison.<jats:italic>Results<\/jats:italic>. The roentgenographic data were measured 3 and 39\u2009\u00b1\u200912 months postoperatively. Twelve patients showed no disability, and eight showed mild disability. Postoperatively, the patients stood with less C2-C7 lordosis, SCA, and CT (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.02<\/mml:mn><\/mml:math>) but with higher NT (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.02<\/mml:mn><\/mml:math>) in comparison to the controls. The patient\u2019s neck disability (NDI) was increasing as TIA increases (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.023<\/mml:mn><\/mml:math>). Subfusion angle seems to adapt to C2-C7 lordosis (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.003<\/mml:mn><\/mml:math>3) and C0-C2 angle (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mi>P<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.003<\/mml:mn><\/mml:math>) without any changes till the last evaluation.<jats:italic>Conclusions<\/jats:italic>. POCF sufficiently restored occipitocervical sagittal balance along with functional outcome similar to controls in adult and elderly individuals with evident upper cervical degeneration. We do not recommend POCF for young active individuals without occipitocervical pathology, but in contrary, we recommend the removal of the spinocranial connection hardware after cervical fusion is completed.<\/jats:p>","DOI":"10.1155\/2020\/7906985","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T23:33:40Z","timestamp":1596324820000},"page":"1-10","source":"Crossref","is-referenced-by-count":5,"title":["Posterior Occipitocervical Fusion for Unstable Upper Cervical Trauma in Old and Elderly Population, Although Decreases Upper Cervical Rotation, Does Not Significantly Increase Neck Disability Index"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5260-0217","authenticated-orcid":true,"given":"Panagiotis","family":"Korovessis","sequence":"first","affiliation":[{"name":"Orthopaedics Department, General Hospital of Patras, Patras 26335, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7015-721X","authenticated-orcid":true,"given":"Vasileios","family":"Syrimpeis","sequence":"additional","affiliation":[{"name":"Orthopaedics Department, General Hospital of Patras, Patras 26335, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelia","family":"Mpountogianni","sequence":"additional","affiliation":[{"name":"Orthopaedics Department, General Hospital of Patras, Patras 26335, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Papaioannou","sequence":"additional","affiliation":[{"name":"Orthopaedics Department, General Hospital of Patras, Patras 26335, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Tsekouras","sequence":"additional","affiliation":[{"name":"Orthopaedics Department, General Hospital of Patras, Patras 26335, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/00005373-197910000-00009","volume":"19","year":"1979","journal-title":"Journal of Trauma"},{"key":"2","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/j.spinee.2010.09.025","volume":"10","year":"2010","journal-title":"The Spine Journal"},{"key":"3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/00000433-199009000-00003","volume":"11","year":"1990","journal-title":"The American Journal of Forensic Medicine and Pathology"},{"key":"4","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1097\/00007632-199410150-00008","volume":"19","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"key":"5","first-page":"429","volume":"4","year":"2006","journal-title":"Journal of Neurosurgery"},{"key":"6","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1097\/BRS.0b013e31817bb0e0","volume":"33","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"key":"7","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/00000658-190805000-00003","volume":"47","year":"1908","journal-title":"Annals of Surgery"},{"key":"8","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/j.spinee.2015.07.003","volume":"15","year":"2015","journal-title":"The Spine Journal"},{"key":"9","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1055\/s-0028-1100920","volume":"1","year":"2010","journal-title":"Evidence-Based Spine-Care Journal"},{"issue":"2","key":"10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jocn.2005.03.031","volume":"13","year":"2006","journal-title":"Journal of Clinical Neuroscience"},{"key":"11","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1097\/00007632-199907150-00007","volume":"24","year":"1999","journal-title":"Spine"},{"key":"12","first-page":"331","volume":"76","year":"2015","journal-title":"Journal of Neurological Surgery"},{"key":"13","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s005860100245","volume":"10","year":"2001","journal-title":"European Spine Journal"},{"issue":"3","key":"14","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1227\/01.NEU.0000365744.54102.B9","volume":"66","year":"2010","journal-title":"Neurosurgery"},{"key":"15","first-page":"223","volume-title":"Fixation options in the occipitocervical junction","year":"2008"},{"key":"16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ocl.2011.08.009","volume":"43","year":"2012","journal-title":"Orthopedic Clinics of North America"},{"key":"17","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/BRS.0b013e31818ff64e","volume":"34","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"issue":"19","key":"18","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1097\/BRS.0000000000001071","volume":"40","year":"2015","journal-title":"Spine"},{"issue":"1","key":"19","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s00586-014-3632-0","volume":"24","year":"2015","journal-title":"European Spine Journal"},{"issue":"9","key":"20","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1007\/s00586-017-5209-1","volume":"26","year":"2017","journal-title":"European Spine Journal"},{"key":"21","doi-asserted-by":"crossref","first-page":"E513","DOI":"10.1097\/BRS.0b013e31828b26df","volume":"38","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"22","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00586-013-2963-6","volume":"23","year":"2014","journal-title":"European Spine Journal"},{"key":"23","first-page":"5","volume":"13","year":"2010","journal-title":"Journal of Neurosurgery"},{"key":"24","doi-asserted-by":"crossref","first-page":"385","DOI":"10.4184\/asj.2016.10.2.385","volume":"10","year":"2016","journal-title":"Asian Spine Journal"},{"issue":"1","key":"25","volume":"9","year":"2019","journal-title":"Global Spine Journal"},{"key":"26","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/1471-2474-9-106","volume":"9","year":"2008","journal-title":"BMC Musculoskelet Disord"},{"issue":"7","key":"27","doi-asserted-by":"crossref","first-page":"E959","DOI":"10.1097\/BSD.0000000000000554","volume":"30","year":"2017","journal-title":"Clinical Spine Surgery"},{"key":"28","doi-asserted-by":"crossref","first-page":"3630","DOI":"10.1007\/s00586-016-4485-5","volume":"25","year":"2016","journal-title":"European Spine Journal"},{"issue":"2","key":"29","doi-asserted-by":"crossref","first-page":"E41","DOI":"10.1097\/BSD.0b013e3182396301","volume":"25","year":"2012","journal-title":"Journal of Spinal Disorders & Techniques"},{"key":"30","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/01.brs.0000259977.69726.6f","volume":"32","year":"2007","journal-title":"Spine"},{"key":"31","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1097\/00007632-199904150-00008","volume":"24","year":"1999","journal-title":"Spine"},{"key":"32","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1227\/00006123-199104000-00015","volume":"28","year":"1991","journal-title":"Neurosurgery"},{"issue":"4","key":"33","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s005860050080","volume":"7","year":"1998","journal-title":"European Spine Journal"},{"issue":"5","key":"34","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1227\/01.NEU.0000312706.47944.35","volume":"63","year":"2008","journal-title":"Neurosurgery"},{"issue":"suppl 6","key":"35","first-page":"S900","volume":"22","year":"2013","journal-title":"European Spine Journal"},{"key":"36","first-page":"34","volume":"1","year":"1985","journal-title":"BHI Q"},{"issue":"suppl 2","key":"37","first-page":"B44","volume":"36","year":"2005","journal-title":"Injury"},{"issue":"suppl 3","key":"38","first-page":"7","volume":"66","year":"2010","journal-title":"Neurosurgery"},{"key":"39","doi-asserted-by":"crossref","first-page":"2880","DOI":"10.1007\/s00586-015-4023-x","volume":"24","year":"2015","journal-title":"European Spine Journal"},{"key":"40","doi-asserted-by":"crossref","first-page":"E1001","DOI":"10.1097\/BRS.0000000000000432","volume":"39","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"41","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1007\/s00586-015-3832-2","volume":"24","year":"2015","journal-title":"European Spine Journal"},{"issue":"3","key":"42","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/01.brs.0000152379.54463.65","volume":"30","year":"2005","journal-title":"Spine"},{"issue":"21","key":"43","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1097\/BRS.0000000000002160","volume":"42","year":"2017","journal-title":"Spine"},{"issue":"23","key":"44","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1097\/BRS.0000000000001698","volume":"41","year":"2016","journal-title":"Spine"},{"key":"45","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s00402-011-1265-x","volume":"131","year":"2011","journal-title":"Archives of Orthopaedic and Trauma Surgery"},{"issue":"suppl 1","key":"46","first-page":"8","volume":"27","year":"2018","journal-title":"European Spine Journal"},{"key":"47","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1097\/BRS.0000000000001644","volume":"41","year":"2016","journal-title":"Spine"},{"key":"48","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/BSD.0b013e31823097f9","volume":"26","year":"2013","journal-title":"Journal of Spinal Disorders & Techniques"},{"issue":"suppl 1","key":"49","first-page":"S14","volume":"76","year":"2015","journal-title":"Neurosurgery"},{"issue":"3","key":"50","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/BF02427845","volume":"8","year":"1986","journal-title":"Surgical and Radiologic Anatomy"},{"key":"51","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3340\/jkns.2013.53.4.223","volume":"53","year":"2013","journal-title":"Journal of Korean Neurosurgical Society"},{"key":"52","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/TA.0b013e31818a5d02","volume":"67","year":"2009","journal-title":"The Journal of Trauma"},{"issue":"2","key":"53","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.spinee.2006.02.024","volume":"7","year":"2007","journal-title":"The Spine Journal"},{"issue":"22","key":"54","doi-asserted-by":"crossref","first-page":"2564","DOI":"10.1097\/01.brs.0000186317.86379.02","volume":"30","year":"2005","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Advances in Orthopedics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/aorth\/2020\/7906985.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/aorth\/2020\/7906985.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/aorth\/2020\/7906985.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T12:16:26Z","timestamp":1667650586000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/aorth\/2020\/7906985\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,1]]},"references-count":54,"alternative-id":["7906985","7906985"],"URL":"https:\/\/doi.org\/10.1155\/2020\/7906985","relation":{},"ISSN":["2090-3464","2090-3472"],"issn-type":[{"value":"2090-3464","type":"print"},{"value":"2090-3472","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,1]]}}}