{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:56:59Z","timestamp":1773449819026,"version":"3.50.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Complete radiographic and clinical evaluations are essential in the surgical treatment of cervical spondylotic myelopathy (CSM). Prior studies have correlated cervical sagittal imbalance and kyphosis with disability and worse health-related quality of life. However, little is known about C2\u20133 disc angle and its correlation with postoperative outcomes. The present study is the first to consider C2\u20133 disc angle as an additional radiographic predictor of postoperative adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A retrospective chart review was performed to identify patients with CSM who underwent surgeries from 2010 to 2014. Data collected included demographics, baseline presenting factors, and postoperative outcomes. Cervical sagittal alignment variables were measured using the preoperative and postoperative radiographs. Univariable logistic regression analyses were used to explore the association between dependent and independent variables, and a multivariable logistic regression model was created using stepwise variable selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The authors identified 171 patients who had complete preoperative and postoperative radiographic and outcomes data. The overall rate of postoperative adverse events was 33% (57\/171), and postoperative C2\u20133 disc angle, C2\u20137 sagittal vertical axis, and C2\u20137 Cobb angle were found to be significantly associated with adverse events. Inclusion of postoperative C2\u20133 disc angle in the analysis led to the best prediction of adverse events. The mean postoperative C2\u20133 disc angle for patients with any postoperative adverse event was 32.3\u00b0 \u00b1 17.2\u00b0, and the mean for those without any adverse event was 22.4\u00b0 \u00b1 11.1\u00b0 (p &lt; 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In the present retrospective analysis of postoperative adverse events in patients with CSM, the authors found a significant association between C2\u20133 disc angle and postoperative adverse events. They propose that C2\u20133 disc angle be used as an additional parameter of cervical spinal sagittal alignment and predictor for operative outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.6.spine1862","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T17:36:22Z","timestamp":1542389782000},"page":"38-45","source":"Crossref","is-referenced-by-count":9,"title":["The effect of C2\u20133 disc angle on postoperative adverse events in cervical spondylotic myelopathy"],"prefix":"10.3171","volume":"30","author":[{"given":"Bryan S.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin M.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad D.","family":"Knusel","sequence":"additional","affiliation":[{"name":"School of Medicine, Case Western Reserve University; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas E.","family":"Mroz","sequence":"additional","affiliation":[{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard P.","family":"Schlenk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iain H.","family":"Kalfas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward C.","family":"Benzel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"22 Suppl 1","key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S149","DOI":"10.1097\/BRS.0b013e3182a7f449","article-title":"Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy","volume":"38","author":"Ames CP","year":"2013","unstructured":"Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, : Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. 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