{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:14:30Z","timestamp":1793060070206,"version":"4.5.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Sagittal spinopelvic malalignment is a significant cause of pain and disability in patients with adult spinal deformity. Surgical correction of spinopelvic malalignment can result in compensatory changes in spinal alignment outside of the fused spinal segments. These compensatory changes, termed reciprocal changes, have been defined for thoracic and lumbar regions but not for the cervical spine. The object of this study was to evaluate postoperative reciprocal changes within the cervical spine following lumbar pedicle subtraction osteotomy (PSO).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a multicenter retrospective radiographic analysis of patients from International Spine Study Group centers. Inclusion criteria were as follows: adults (&gt;18 years old) with spinal deformity treated using lumbar PSO, a preoperative C7\u2013S1 plumb line greater than 5 cm, and availability of pre- and postoperative full-length standing radiographs.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Seventy-five patients (60 women, mean age 59 years) were included. The lumbar PSO significantly improved sagittal alignment, including the C7\u2013S1 plumb line, C7\u2013T12 inclination, and pelvic tilt (p &lt;0.001). After lumbar PSO, reciprocal changes were seen to occur in C2\u20137 cervical lordosis (from 30.8\u00b0 to 21.6\u00b0, p &lt;0.001), C2\u20137 plumb line (from 27.0 mm to 22.9 mm), and T-1 slope (from \u221238.9\u00b0 to \u221230.4\u00b0, p &lt;0.001). Ideal correction of sagittal malalignment (postoperative sagittal vertical alignment &lt; 50 mm) was associated with the greatest relaxation of cervical hyperlordosis (\u221212.4\u00b0 vs \u22125.7\u00b0, p = 0.037). A change in cervical lordosis correlated with changes in T-1 slope (r = \u22120.621, p &lt;0.001), C7\u2013T12 inclination (r = 0.418, p &lt;0.001), T12\u2013S1 angle (r = \u22120.339, p = 0.005), and C7\u2013S1 plumb line (r = 0.289, p = 0.018). Radiographic parameters that correlated with changes in cervical lordosis on multivariate linear regression analysis included change in T-1 slope and change in C2\u20137 plumb line (r<jats:sup>2<\/jats:sup> = 0.53, p &lt;0.001).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Adults with positive sagittal spinopelvic malalignment compensate with abnormally increased cervical lordosis in an effort to maintain horizontal gaze. Surgical correction of sagittal malalignment results in improvement of the abnormal cervical hyperlordosis through reciprocal changes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.6.spine1250","type":"journal-article","created":{"date-parts":[[2012,8,3]],"date-time":"2012-08-03T14:02:27Z","timestamp":1344002547000},"page":"300-307","source":"Crossref","is-referenced-by-count":142,"title":["Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy"],"prefix":"10.3171","volume":"17","author":[{"given":"Justin S.","family":"Smith","sequence":"first","affiliation":[{"name":"1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"2Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Blondel","sequence":"additional","affiliation":[{"name":"2Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"2Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"3Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hart","sequence":"additional","affiliation":[{"name":"4Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"O'Shaughnessy","sequence":"additional","affiliation":[{"name":"5Department of Neurosurgery, Howell Allen Clinic, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"6Orthopedic Center, Rocky Mountain Hospital for Children, Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena S.","family":"Hu","sequence":"additional","affiliation":[{"name":"7Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"7Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"8Neurosurgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine1250","unstructured":"Blondel B, Schwab F, Ames CP, LeHuec JC, Smith JS, Demakakos J, The crucial role of cervical alignment in regulating sagittal spino-pelvic alignment in human standing posture. 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