{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:52:01Z","timestamp":1791388321428,"version":"4.3.3"},"reference-count":81,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:list list-type=\"plain\">\n                        <jats:list-item>\n                          <jats:p>\u27a2 For isolated cervical deformities in patients with good bone health, the upper instrumented vertebra can be C3 or C4.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 For patients with global cervical deformity, poor bone health, planned 3-column osteotomies, or long fusion constructs, C2 may be an appropriate upper instrumented vertebra.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 For patients with focal kyphosis, optimal sagittal alignment, and preserved bone stock, a lower instrumented vertebra cranial to the cervicothoracic junction is appropriate.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 For patients with poor cervical sagittal alignment, a lower instrumented vertebra in the proximal thoracic spine, ranging from T1 to T3, may be appropriate.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\u27a2 For combined cervical and thoracolumbar spinal deformities, a lower instrumented vertebra in the lower thoracic or upper lumbar spine is appropriate. The sagittal stable vertebra or first lordotic vertebra concepts can be considered.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01540","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:00:26Z","timestamp":1787853626000},"page":"1510-1519","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Principles of Level Selection for Instrumentation in Adult Cervical Spinal Deformity Surgery"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8417-3798","authenticated-orcid":false,"given":"Zeeshan M.","family":"Sardar","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, Och Spine at NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4033-4905","authenticated-orcid":false,"given":"Josephine R.","family":"Coury","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, Och Spine at NewYork-Presbyterian Hospital, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7769-1557","authenticated-orcid":false,"given":"Anson G.","family":"Bautista","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Dwight D. 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