{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:24:40Z","timestamp":1791617080935,"version":"4.3.4"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"OBJECTIVE<\/jats:title>The Ames\u2013International Spine Study Group (ISSG) classification has recently been proposed as a tool for adult cervical deformity evaluation. This classification includes three radiographic cervical sagittal modifiers that have not been evaluated in asymptomatic adults. The aim of this study was to determine whether the sagittal radiographic modifiers described in the Ames-ISSG cervical classification are encountered in asymptomatic adults without alteration of health-related quality of life (HRQOL).<\/jats:p><\/jats:sec>METHODS<\/jats:title>The authors conducted a cross-sectional study of subjects with an age \u2265 18 years and no cervical or back-related complaints or history of orthopedic surgery. All subjects underwent full-body biplanar radiographs with the measurement of cervical, segmental, and global alignment and completed the SF-36 HRQOL questionnaire. Subjects were classified according to the sagittal radiographic modifiers (chin-brow vertical angle [CBVA], mismatch between T1 slope and cervical lordosis [TS-CL], and C2\u20137 sagittal vertical axis [cSVA]) of the Ames\u2013ISSG classification for cervical deformity, which also includes a qualitative descriptor of cervical deformity, the modified Japanese Orthopaedic Association (mJOA) myelopathy score, and the Scoliosis Research Society (SRS)\u2013Schwab classification for spinal deformity assessment. Characteristics of the subjects classified by the different modifier grades were compared.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>One hundred forty-one asymptomatic subjects (ages 18\u201359 years, 71 females) were enrolled in the study. Twenty-seven (19.1%) and 61 (43.3%) subjects were classified as grade 1 in terms of the TS-CL and CBVA modifiers, respectively. Ninety-eight (69.5%) and 4 (2.8%) were grade 2 for these same respective modifiers. One hundred thirty-six (96.5%) subjects had at least one modifier at grade 1 or 2. There was a significant relationship between patient age and grades of TS-CL (p < 0.001, Cramer\u2019s V [CV] = 0.32) and CBVA (p = 0.04, CV = 0.22) modifiers. The HRQOL, global alignment, and segmental alignment parameters were similar among the subjects with different modifier grades (p > 0.05).<\/jats:p><\/jats:sec>CONCLUSIONS<\/jats:title>The CBVA and TS-CL radiographic modifiers of the Ames-ISSG classification do not seem to be specific to subjects with cervical deformities and can occur in asymptomatic subjects without alteration in HRQOL.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.2.spine171285","type":"journal-article","created":{"date-parts":[[2018,7,27]],"date-time":"2018-07-27T14:01:53Z","timestamp":1532700113000},"page":"483-490","source":"Crossref","is-referenced-by-count":21,"title":["Are the sagittal cervical radiographic modifiers of the Ames-ISSG classification specific to adult cervical deformity?"],"prefix":"10.3171","volume":"29","author":[{"given":"Ziad","family":"Bakouny","sequence":"first","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Khalil","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joeffroy","family":"Otayek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aren Joe","family":"Bizdikian","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fares","family":"Yared","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Salameh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naji","family":"Bou Zeid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismat","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"},{"name":"H\u00f4tel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalil","family":"Kharrat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"},{"name":"H\u00f4tel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaby","family":"Kreichati","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"},{"name":"H\u00f4tel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Spine Division, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Spine Division, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Assi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.nec.2012.12.007","article-title":"Use of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation","volume":"24","author":"Akbar M","year":"2013","unstructured":"Akbar M, Terran J, Ames CP, Lafage V, Schwab F: Use of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation. 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