{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:21:31Z","timestamp":1781144491200,"version":"3.54.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,6]]},"abstract":"\nOBJECT<\/jats:title>\nAlignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nThe authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV \u2265 L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2\u20137 cervical lordosis (CL), C2\u20137 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2\u201312 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS).<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nFifty-seven patients with a mean age of 49.1 \u00b1 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15\u00b0) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2\u20137 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV \u2265 L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK \u2265 60\u00b0 (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen.<\/jats:p><\/jats:sec>\n\nCONCLUSION<\/jats:title>\nIncreased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2\u20137 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.spine14829","type":"journal-article","created":{"date-parts":[[2015,3,20]],"date-time":"2015-03-20T14:44:39Z","timestamp":1426862679000},"page":"658-665","source":"Crossref","is-referenced-by-count":42,"title":["Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up"],"prefix":"10.3171","volume":"22","author":[{"given":"Taemin","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Scripps Clinic, San Diego;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacramento;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacramento;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Rocky Mountain Hospital for Children, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3 Suppl","key":"b1-spine14829","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1227\/01.NEU.0000320425.55569.21","article-title":"Radiographic measurement techniques","volume":"63","author":"Angevine","year":"2008"},{"key":"b2-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1097\/BRS.0b013e3181b05146","article-title":"Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients","volume":"34","author":"Bess","year":"2009"},{"issue":"19 Suppl","key":"b3-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1097\/01.brs.0000231963.72810.38","article-title":"Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs vertebral column resection for spinal deformity","volume":"31","author":"Bridwell","year":"2006"},{"key":"b4-spine14829","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1007\/s00586-005-0927-1","article-title":"Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies","volume":"15","author":"Champain","year":"2006"},{"key":"b5-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1097\/01.brs.0000155425.04536.f7","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman","year":"2005"},{"key":"b6-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005"},{"key":"b7-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1097\/BRS.0b013e318191e792","article-title":"Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients","volume":"34","author":"Jang","year":"2009"},{"key":"b8-spine14829","series-title":"Adv Orthop","first-page":"415946","article-title":"Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment","volume":"2011","author":"Klineberg","year":"2011"},{"key":"b9-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E180","DOI":"10.1097\/BRS.0b013e318225b926","article-title":"Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis","volume":"37","author":"Lafage","year":"2012"},{"key":"b10-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E599","DOI":"10.1097\/BRS.0b013e3181aad219","article-title":"Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity","volume":"34","author":"Lafage","year":"2009"},{"key":"b11-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1097\/BRS.0b013e31817886a2","article-title":"Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters","volume":"33","author":"Lafage","year":"2008"},{"key":"b12-spine14829","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1007\/s00586-011-1967-3","article-title":"Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity","volume":"21","author":"Lafage","year":"2012"},{"key":"b13-spine14829","series-title":"J Manipulative Physiol Ther","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jmpt.2005.02.015","article-title":"Determining the relationship between cervical lordosis and neck complaints","volume":"28","author":"McAviney","year":"2005"},{"key":"b14-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1097\/BRS.0b013e3181dccd63","article-title":"Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis","volume":"35","author":"Newton","year":"2010"},{"key":"b15-spine14829","series-title":"Spinal Deformity Study Group Radiographic Measurement Manual","year":"2005"},{"key":"b16-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2893","DOI":"10.1097\/BRS.0b013e3181c40bf2","article-title":"Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity","volume":"34","author":"O'Shaughnessy","year":"2009"},{"key":"b17-spine14829","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.spinee.2007.11.010","article-title":"Lumbar curve response to selective thoracic fusion in adult idiopathic scoliosis","volume":"8","author":"Peelle","year":"2008"},{"key":"b18-spine14829","series-title":"Rev Chir Orthop Reparatrice Appar Mot","first-page":"218","article-title":"[Validation of a tool to measure pelvic and spinal parameters of sagittal balance.]","volume":"89","author":"Rillardon","year":"2003"},{"key":"b19-spine14829","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"141","DOI":"10.3171\/2013.4.SPINE12838","article-title":"Cervical spine alignment, sagittal deformity, and clinical implications. A review","volume":"19","author":"Scheer","year":"2013"},{"key":"b20-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1097\/01.BRS.0000049924.94414.BB","article-title":"Adult scoliosis: a health assessment analysis by SF-36","volume":"28","author":"Schwab","year":"2003"},{"key":"b21-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1097\/BRS.0b013e3181a13c08","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab","year":"2009"},{"key":"b22-spine14829","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1097\/BRS.0b013e3181ee6bd4","article-title":"Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","volume":"35","author":"Schwab","year":"2010"},{"key":"b23-spine14829","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3171\/SPI.2008.9.10.326","article-title":"Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management","volume":"9","author":"Smith","year":"2008"},{"key":"b24-spine14829","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.nec.2012.12.009","article-title":"Clinical and radiographic evaluation of the adult spinal deformity patient","volume":"24","author":"Smith","year":"2013"},{"key":"b25-spine14829","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3171\/2012.6.SPINE1250","article-title":"Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy","volume":"17","author":"Smith","year":"2012"},{"key":"b26-spine14829","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/NEU.0b013e31826100c9","article-title":"The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery","volume":"71","author":"Tang","year":"2012"},{"key":"b27-spine14829","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1227\/NEU.0b013e31820b51f3","article-title":"Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment","volume":"68","author":"Villavicencio","year":"2011"},{"key":"b28-spine14829","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1007\/s00586-011-1771-0","article-title":"Vertebral column decancellation for the management of sharp angular spinal deformity","volume":"20","author":"Wang","year":"2011"},{"key":"b29-spine14829","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3171\/spi.2006.5.1.9","article-title":"Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance","volume":"5","author":"Yang","year":"2006"},{"key":"b30-spine14829","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1055\/s-0032-1326950","article-title":"Current status of adult spinal deformity","volume":"3","author":"Youssef","year":"2013"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/6\/article-p658.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/6\/article-p658.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/22\/6\/article-p658.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T21:24:09Z","timestamp":1681593849000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/22\/6\/article-p658.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6]]},"references-count":30,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.spine14829","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2015,6]]}}}