{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:52:14Z","timestamp":1791571934200,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n \n \n \u27a2 Standing full-spine radiographs are mandatory for cervical deformity evaluation; key alignment targets include cervical sagittal vertical axis (cSVA) of \u226440 mm, T1 slope minus cervical lordosis (T1S \u2212 CL) of <15\u00b0, and a chin-brow vertical angle (CBVA) between \u221210\u00b0 and +10\u00b0 relative to the true vertical. The achievement of these thresholds is independently associated with better patient-reported outcomes, whereas values outside these ranges are associated with worse disability and quality-of-life scores.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 The Kim-International Spine Study Group (ISSG) morphology-based classification, which identifies 4 patterns (flat neck, focal, cervicothoracic, and coronal or complex) from standing and dynamic extension radiographs, provides a reproducible morphology and flexibility-based framework that informs operative planning and has demonstrated superior interrater and intrarater reliability over prior descriptive systems; final surgical decisions integrate flexibility, neurological status, global alignment, bone quality, and patient-specific factors, and the direct impact of this classification on surgical outcomes requires further prospective validation.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Surgical planning is stratified by the intended lower instrumented vertebra (LIV) (Type 1: LIV T2-T4; Type 2: within the cervical spine or cervicothoracic junction; Type 3: extending past the thoracolumbar junction) and by whether the deformity is ankylosed, which determines the need for osteotomy.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Overall complication rates exceed 50% in prospective multicenter data; systematic risk mitigation, including neuromonitoring, tranexamic acid, staged approaches, and frailty-based patient selection, is essential for safe outcomes.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Despite high complication rates, the surgical correction of cervical deformity yields clinically meaningful improvements in pain and health-related quality of life at 1 year in appropriately selected patients; realistic goal-setting and individualized alignment targets are the keys to durable success.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n 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