{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:08:01Z","timestamp":1786118881972,"version":"build-2736575974"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Narrative review and conceptual framework proposal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To reframe anterior cervical osteotomy (ACO) as a biomechanical continuum and propose a mechanism-based decision framework \u201cthe ACO Triad\u201d integrating alignment, stability, and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature review was performed across PubMed, Embase, and Web of Science to identify studies representative of distinct ACO biomechanical mechanisms. Unlike traditional hierarchical classifications based on resection volume, techniques were analyzed and synthesized into a four-tier continuum based on their dominant correction mechanism: from disc-level release to vertebral-body translation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Content and Findings<\/jats:title>\n                    <jats:p>The literature review suggests that sagittal alignment outcomes are governed by the mechanism of apical control (hinging vs. translation) rather than the volume of bone removed. We organized strategies into four tiers: Tier I leverages disc-level release for segmental hinging; Tier II utilizes targeted retro-corporeal decompression; Tier III encompasses traditional corpectomy, which exhibits a \u201ccorrection ceiling\u201d and stability trade-offs with longer spans; and Tier IV (e.g., VBSO, ACAF) utilizes vertebral body translation for indirect decompression. The \u201cACO Triad\u201d framework explains the trade-offs: while corpectomy (Tier III) increases resection, it may compromise stability (load-sharing) and safety in adhesive disease. Conversely, translation techniques (Tier IV) decouple decompression from resection, altering the safety profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anterior cervical osteotomy is best understood as a mechanism-driven continuum. By integrating alignment, stability, and safety, the ACO Triad provides a rational foundation for surgical decision-making, shifting planning from a resection hierarchy toward biomechanical intent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261476603","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:37:57Z","timestamp":1785843477000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Cervical Osteotomy: A Narrative Review and Proposal of a Mechanism-Based Decision Framework (The ACO Triad)"],"prefix":"10.1177","author":[{"given":"Hao-Chiun","family":"Chang","sequence":"first","affiliation":[{"name":"Mackay Memorial Hospital"},{"name":"Mackay Medical 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