{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:09Z","timestamp":1787025729365,"version":"build-2736575974"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n OBJECT<\/jats:title>\n Regional cervical sagittal alignment (C2\u20137 sagittal vertical axis [SVA]) has been shown to correlate with health-related quality of life (HRQOL). The study objective was to examine the relationship between cervical and thoracolumbar alignment parameters with HRQOL among patients with operative and nonoperative adult thoracolumbar deformity.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This is a multicenter prospective data collection of consecutive patients with adult thoracolumbar spinal deformity. Clinical measures of disability included the Oswestry Disability Index (ODI), Scoliosis Research Society-22 Patient Questionnaire (SRS-22), and 36-Item Short-Form Health Survey (SF-36). Cervical radiographic parameters were correlated with global sagittal parameters within the nonoperative and operative cohorts. A partial correlation analysis was performed controlling for C-7 SVA. The operative group was subanalyzed by the magnitude of global deformity (C-7 SVA \u2265 5 cm vs < 5 cm).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 318 patients were included (186 operative and 132 nonoperative). The mean age was 55.4 \u00b1 14.9 years. Operative patients had significantly worse baseline HRQOL and significantly larger C-7 SVA, pelvic tilt (PT), mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C2-7 SVA. The operative patients with baseline C-7 SVA \u2265 5 cm had significantly larger C2-7 lordosis (CL), C2-7 SVA, C-7 SVA, PI-LL, and PT than patients with a normal C-7 SVA. For all patients, baseline C2-7 SVA and CL significantly correlated with baseline ODI, Physical Component Summary (PCS), SRS Activity domain, and SRS Appearance domain. Baseline C2-7 SVA also correlated with SRS Pain and SRS Total. For the operative patients with baseline C-7 SVA \u2265 5 cm, the 2-year C2-7 SVA significantly correlated with 2-year Mental Component Summary, SRS Mental, SRS Satisfaction, and decreases in ODI. Decreases in C2-7 SVA at 2 years significantly correlated with lower ODI at 2 years. Using partial correlations while controlling for C-7 SVA, the C2-7 SVA correlated significantly with baseline ODI (r = 0.211, p = 0.002), PCS (r = \u22120.178, p = 0.009), and SRS Activity (r = \u22120.145, p = 0.034) for the entire cohort. In the subset of operative patients with larger thoracolumbar deformities, the change in C2-7 SVA correlated with change in ODI (r = \u22120.311, p = 0.03).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Changes in cervical lordosis correlate to HRQOL improvements in thoracolumbar deformity patients at 2-year follow-up. Regional cervical sagittal parameters such as CL and C2\u20137 SVA are correlated with clinical measures of regional disability and health status in patients with adult thoracolumbar scoliosis. This effect may be direct or a reciprocal effect of the underlying global deformities on regional cervical alignment. However, the partial correlation analysis, controlling for the magnitude of the thoracolumbar deformity, suggests that there is a direct effect of cervical alignment on health measures. Improvements in regional cervical alignment postoperatively correlated positively with improved HRQOL.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.11.spine1441","type":"journal-article","created":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T10:35:22Z","timestamp":1431686122000},"page":"153-158","source":"Crossref","is-referenced-by-count":124,"title":["How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up"],"prefix":"10.3171","volume":"23","author":[{"given":"Themistocles S.","family":"Protopsaltis","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"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":"Jamie S.","family":"Terran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"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":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian M.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California;"}],"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":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Rocky Mountain Hospital for Children, Denver, Colorado; and"}],"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":"Department of Neurological Surgery, 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-spine1441","series-title":"A review J Neuro-surg Spine","first-page":"547","article-title":"Impact of spinopelvic alignment on decision making in deformity surgery in adults","volume":"16","author":"Ames","year":"2012"},{"key":"b2-spine1441","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1097\/BRS.0b013e3181efa06a","article-title":"Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up","volume":"35","author":"Bridwell","year":"2010"},{"key":"b3-spine1441","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2220","DOI":"10.1097\/BRS.0b013e31814cf120","article-title":"Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery?","volume":"32","author":"Bridwell","year":"2007"},{"key":"b4-spine1441","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-spine1441","series-title":"J Clin Epidemiol","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994"},{"key":"b6-spine1441","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":"b7-spine1441","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":"b8-spine1441","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-spine1441","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-spine1441","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":"b11-spine1441","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E519","DOI":"10.1097\/BRS.0b013e3181a9c7ad","article-title":"Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis?","volume":"34","author":"Mac-Thiong","year":"2009"},{"key":"b12-spine1441","series-title":"You scratch my neck, I\u2019ll scratch your back: towards a total disability assessment model","author":"Ryan"},{"key":"b13-spine1441","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? 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