{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:44:34Z","timestamp":1784810674044,"version":"3.55.0"},"reference-count":31,"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":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The goal of this study was to investigate the impact of thoracic and lumbar alignment on cervical alignment in patients with adolescent idiopathic scoliosis (AIS).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Eighty-one patients with AIS who had a Cobb angle &gt; 40\u00b0 and full-length spine radiographs were included. Radiographs were analyzed using dedicated software to measure pelvic parameters (sacral slope [SS], pelvic incidence [PI], pelvic tilt [PT]); regional parameters (C1 slope, C0\u2013C2 angle, chin-brow vertical angle [CBVA], slope of line of sight [SLS], McRae slope, McGregor slope [MGS], C2\u20137 [cervical lordosis; CL], C2\u20137 sagittal vertical axis [SVA], C2\u2013T3, C2\u2013T3 SVA, C2\u2013T1 Harrison measurement [C2\u2013T1 Ha], T1 slope, thoracic kyphosis [TK], lumbar lordosis [LL], and PI-LL mismatch); and global parameters (SVA). Patients were stratified by their lumbar alignment into hyperlordotic (LL &gt; 59.7\u00b0) and normolordotic (LL 39.3\u00b0 to 59.7\u00b0) groups and also, based on their thoracic alignment, into hypokyphotic (TK &lt; \u221233.1\u00b0) and normokyphotic (TK \u221233.1\u00b0 to \u221254.9\u00b0) groups. Finally, they were grouped based on their global alignment into either an anterior-aligned group or a posterior-aligned group.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The lumbar hyperlordotic group, in comparison to the normolordotic group, had a significantly larger LL, SS, PI (all p &lt; 0.001), and TK (p = 0.014) and a significantly smaller PI-LL mismatch (p = 0.001). Lumbar lordosis had no influence on local cervical parameters.<\/jats:p><jats:p>The thoracic hypokyphotic group had a significantly larger PI-LL mismatch (p &lt; 0.002) and smaller T1 slope (p &lt; 0.001), and was significantly more posteriorly aligned than the normokyphotic group (\u221215.02 \u00b1 8.04 vs 13.54 \u00b1 6.17 [mean \u00b1 SEM], p = 0.006). The patients with hypokyphotic AIS had a kyphotic cervical spine (cervical kyphosis [CK]) (p &lt; 0.001). Furthermore, a posterior-aligned cervical spine in terms of C2\u20137 SVA (p &lt; 0.006) and C2\u2013T3 SVA (p &lt; 0.001) was observed in the thoracic hypokyphotic group.<\/jats:p><jats:p>Comparing patients in terms of global alignment, the posterior-aligned group had a significantly smaller T1 slope (p &lt; 0.001), without any difference in terms of pelvic, lumbar, and thoracic parameters when compared to the anterior-aligned group. The posterior-aligned group also had a CK (\u22129.20 \u00b1 1.91 vs 5.21 \u00b1 2.95 [mean \u00b1 SEM], p &lt; 0.001) and a more posterior-aligned cervical spine, as measured by C2\u20137 SVA (p = 0.003) and C2\u2013T3 SVA (p &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Alignment of the cervical spine is closely related to thoracic curvature and global alignment. In patients with AIS, a hypokyphotic thoracic alignment or posterior global alignment was associated with a global cervical kyphosis. Interestingly, upper cervical and cranial parameters were not statistically different in all investigated groups, meaning that the upper cervical spine was not recruited for compensation in order to maintain a horizontal gaze.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.3.spine171263","type":"journal-article","created":{"date-parts":[[2018,8,24]],"date-time":"2018-08-24T14:01:47Z","timestamp":1535119307000},"page":"506-514","source":"Crossref","is-referenced-by-count":30,"title":["Sagittal alignment of the cervical spine in the setting of adolescent idiopathic scoliosis"],"prefix":"10.3171","volume":"29","author":[{"given":"Michael","family":"Akbar","sequence":"first","affiliation":[{"name":"Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidara","family":"Almansour","sequence":"additional","affiliation":[{"name":"Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Wiedenh\u00f6fer","sequence":"additional","affiliation":[{"name":"ATOS Clinic Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Pepke","sequence":"additional","affiliation":[{"name":"Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s00586-015-3868-3","article-title":"Sagittal alignment of cervical spine in adult idiopathic scoliosis","volume":"24","author":"Aykac B","year":"2015","unstructured":"Aykac B, Ayhan S, Yuksel S, Guler UO, Pellise F, Alanay A, : Sagittal alignment of cervical spine in adult idiopathic scoliosis. 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