{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T12:56:49Z","timestamp":1755694609564,"version":"3.41.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the authors aimed to investigate the complementary questions of whether cervical alignment induces a change in global alignment and whether this change stabilizes over time.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>To analyze spontaneous changes, this study included only patients with at least 5 levels remaining unfused following surgery. After data were obtained for the entire cohort, repeated-measures analyses were conducted between preoperative baseline and 3-month and 1-year follow-ups with a post hoc analysis and Bonferroni correction. A subanalysis of patients with 2-year follow-up was performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>One-year follow-up data were available for 121 of 168 patients (72%), and 89 patients had at least 5 levels remaining unfused following surgery. Preoperatively there was a moderate anterior cervical alignment (C2\u20137, \u22127.7\u00b0 [kyphosis]; T1 slope minus cervical lordosis, 37.1\u00b0; cervical sagittal vertebral axis [cSVA], 37 mm) combined with a posterior global alignment (SVA, \u22128 mm) with lumbar hyperextension (pelvic incidence [PI] minus lumbar lordosis [LL] mismatch [PI-LL], \u22120.6\u00b0). Patients underwent a significant correction of the cervical alignment (median \u0394C2\u20137, 13.6\u00b0). Simultaneously, PI-LL, T1 pelvic angle (TPA), and SVA increased significantly (all p &lt; 0.05) between baseline and 3-month and 1-year follow-ups. Post hoc analysis demonstrated that all of the changes occurred between baseline and 3 months. Subanalysis of patients with complete 2-year follow-up demonstrated similar results, with stable postoperative thoracolumbar alignment achieved at 3 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Correction of cervical malalignment can have a significant impact on thoracolumbar regional and global alignment. Peak relaxation of compensatory mechanisms is achieved by the 3-month follow-up and tends to remain stable. Subanalysis with 2-year data further supports this finding. These findings can help to identify when the results of cervical surgery on global alignment can be best evaluated.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2021.7.spine21306","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T07:28:42Z","timestamp":1636097322000},"page":"616-623","source":"Crossref","is-referenced-by-count":2,"title":["When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery?"],"prefix":"10.3171","volume":"36","author":[{"given":"Renaud","family":"Lafage","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basel","family":"Sheikh Alshabab","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"Scripps Clinic, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1093\/neuros\/nyx028","article-title":"The health impact of adult cervical deformity in patients presenting for surgical treatment: comparison to United States population norms and chronic disease states based on the EuroQuol-5 Dimensions questionnaire","volume":"80","author":"Smith JS","year":"2017","unstructured":"Smith JS, \nLine B, \nBess S, \nShaffrey CI, \nKim HJ, \nMundis G, \n\n \nThe health impact of adult cervical deformity in patients presenting for surgical treatment: comparison to United States population norms and chronic disease states based on the EuroQuol-5 Dimensions questionnaire. \nNeurosurgery. \n2017;\n80(\n5):\n716\u2013\n725.\n2836852410.1093\/neuros\/nyx028"},{"issue":"10","key":"b2","series-title":"Clin Spine Surg","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/BSD.0000000000000743","article-title":"Cervical versus thoracolumbar spinal deformities: a comparison of baseline quality-of-life burden","volume":"31","author":"Passias PG","year":"2018","unstructured":"Passias PG, \nPoorman GW, \nLafage V, \nSmith J, \nAmes C, \nSchwab F, \n\n \nCervical versus thoracolumbar spinal deformities: a comparison of baseline quality-of-life burden. \nClin Spine Surg. \n2018;\n31(\n10):\n413\u2013\n419.\n3037160010.1097\/BSD.0000000000000743"},{"issue":"2","key":"b3","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3171\/2014.11.SPINE1441","article-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","volume":"23","author":"Protopsaltis TS","year":"2015","unstructured":"Protopsaltis TS, \nScheer JK, \nTerran JS, \nSmith JS, \nHamilton DK, \nKim HJ, \n\n \nHow 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. \nJ Neurosurg Spine. \n2015;\n23(\n2):\n153\u2013\n158.\n2597807710.3171\/2014.11.SPINE1441"},{"issue":"13","key":"b4","series-title":"Spine","doi-asserted-by":"publisher","first-page":"E773","DOI":"10.1097\/BRS.0000000000002524","article-title":"Analysis of successful versus failed radiographic outcomes after cervical deformity surgery","volume":"43","author":"Protopsaltis TS","year":"2018","unstructured":"Protopsaltis TS, \nRamchandran S, \nHamilton DK, \nSciubba D, \nPassias PG, \nLafage V, \n\n \nAnalysis of successful versus failed radiographic outcomes after cervical deformity surgery. \nSpine (Phila Pa 1976).\n2018;\n43(\n13):\nE773\u2013\nE781.\n10.1097\/BRS.000000000000252429227365"},{"issue":"2","key":"b5","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"182","DOI":"10.3171\/2019.7.SPINE18651","article-title":"Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery","volume":"32","author":"Horn SR","year":"2019","unstructured":"Horn SR, \nPassias PG, \nOh C, \nLafage V, \nLafage R, \nSmith JS, \n\n \nPredicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery. \nJ Neurosurg Spine. \n2019;\n32(\n2):\n182\u2013\n190.\n10.3171\/2019.7.SPINE1865131675700"},{"issue":"22)(suppl 1","key":"b6","series-title":"Spine","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, \nBlondel B, \nScheer JK, \nSchwab FJ, \nLe Huec JC, \nMassicotte EM, \n\n \nCervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. \nSpine (Phila Pa 1976).\n2013;\n38(\n22)(suppl 1):\nS149\u2013\nS160.\n10.1097\/BRS.0b013e3182a7f44924113358"},{"issue":"5","key":"b7","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1227\/NEU.0000000000001128","article-title":"Assessment of impact of long-cassette standing X-rays on surgical planning for cervical pathology: an international survey of spine surgeons","volume":"78","author":"Ramchandran S","year":"2016","unstructured":"Ramchandran S, \nSmith JS, \nAilon T, \nKlineberg E, \nShaffrey C, \nLafage V, \n\n \nAssessment of impact of long-cassette standing X-rays on surgical planning for cervical pathology: an international survey of spine surgeons. \nNeurosurgery. \n2016;\n78(\n5):\n717\u2013\n724.\n10.1227\/NEU.000000000000112826619335"},{"issue":"23","key":"b8","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1097\/BRS.0000000000001642","article-title":"Variations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs","volume":"41","author":"Iyer S","year":"2016","unstructured":"Iyer S, \nLenke LG, \nNemani VM, \nAlbert TJ, \nSides BA, \nMetz LN, \n\n \nVariations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. \nSpine (Phila Pa 1976).\n2016;\n41(\n23):\n1826\u2013\n1836.\n10.1097\/BRS.000000000000164227111763"},{"issue":"4","key":"b9","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 JS","year":"2012","unstructured":"Smith JS, \nShaffrey CI, \nLafage V, \nBlondel B, \nSchwab F, \nHostin R, \n\n \nSpontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. \nJ Neurosurg Spine. \n2012;\n17(\n4):\n300\u2013\n307.\n10.3171\/2012.6.SPINE125022860879"},{"issue":"5","key":"b10","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1093\/neuros\/nyx288","article-title":"Global spinal alignment in cervical kyphotic deformity: the importance of head position and thoracolumbar alignment in the compensatory mechanism","volume":"82","author":"Mizutani J","year":"2018","unstructured":"Mizutani J, \nVerma K, \nEndo K, \nIshii K, \nAbumi K, \nYagi M, \n\n \nGlobal spinal alignment in cervical kyphotic deformity: the importance of head position and thoracolumbar alignment in the compensatory mechanism. \nNeurosurgery. \n2018;\n82(\n5):\n686\u2013\n694.\n2859178110.1093\/neuros\/nyx288"},{"issue":"6","key":"b11","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 S","year":"2006","unstructured":"Champain S, \nBenchikh K, \nNogier A, \nMazel C, \nGuise JD, \nSkalli W\n. \nValidation of new clinical quantitative analysis software applicable in spine orthopaedic studies. \nEur Spine J. \n2006;\n15(\n6):\n982\u2013\n991.\n10.1007\/s00586-005-0927-115965708"},{"issue":"12","key":"b12","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1016\/j.spinee.2015.08.067","article-title":"Validation of a new computer-assisted tool to measure spino-pelvic parameters","volume":"15","author":"Lafage R","year":"2015","unstructured":"Lafage R, \nFerrero E, \nHenry JK, \nChallier V, \nDiebo B, \nLiabaud B, \n\n \nValidation of a new computer-assisted tool to measure spino-pelvic parameters. \nSpine J. \n2015;\n15(\n12):\n2493\u2013\n2502.\n2634324310.1016\/j.spinee.2015.08.067"},{"issue":"2","key":"b13","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1007\/s00586-017-5395-x","article-title":"Prospective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity","volume":"27","author":"Ramchandran S","year":"2018","unstructured":"Ramchandran S, \nProtopsaltis TS, \nSciubba D, \nScheer JK, \nJalai CM, \nDaniels A, \n\n \nProspective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity. \nEur Spine J. \n2018;\n27(\n2):\n416\u2013\n425.\n10.1007\/s00586-017-5395-x29185112"},{"issue":"9","key":"b14","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1016\/j.spinee.2016.05.008","article-title":"Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area","volume":"16","author":"Hyun SJJ","year":"2016","unstructured":"Hyun SJJ, \nKim YJ, \nRhim SCC\n. \nPatients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. \nSpine J. \n2016;\n16(\n9):\n1095\u2013\n1101.\n2721733210.1016\/j.spinee.2016.05.008"},{"issue":"3","key":"b15","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3171\/2019.3.SPINE19108","article-title":"Paraspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion","volume":"31","author":"Pennington Z","year":"2019","unstructured":"Pennington Z, \nCottrill E, \nAhmed AK, \nPassias P, \nProtopsaltis T, \nNeuman B, \n\n \nParaspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion. \nJ Neurosurg Spine. \n2019;\n31(\n3):\n380\u2013\n388.\n3115110710.3171\/2019.3.SPINE19108"},{"issue":"13","key":"b16","series-title":"Spine","doi-asserted-by":"publisher","first-page":"E791","DOI":"10.1097\/BRS.0000000000001386","article-title":"Sagittal correction and reciprocal changes after thoracic pedicle subtraction osteotomy","volume":"41","author":"Cacho-Rodrigues P","year":"2016","unstructured":"Cacho-Rodrigues P, \nCampana M, \nObeid I, \nVital JM, \nGille O\n. \nSagittal correction and reciprocal changes after thoracic pedicle subtraction osteotomy. \nSpine (Phila Pa 1976).\n2016;\n41(\n13):\nE791\u2013\nE797.\n2665603910.1097\/BRS.0000000000001386"},{"issue":"3","key":"b17","series-title":"Adv Orthop","doi-asserted-by":"publisher","first-page":"415946","DOI":"10.4061\/2011\/415946","article-title":"Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment","volume":"2011","author":"Klineberg E","year":"2011","unstructured":"Klineberg E, \nSchwab F, \nAmes C, \nHostin R, \nBess S, \nSmith JS, \n\n \nAcute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment. \nAdv Orthop. \n2011;\n2011(\n3):\n415946.\n10.4061\/2011\/41594622007318"},{"issue":"3","key":"b18","series-title":"J Craniovertebr Junction Spine","doi-asserted-by":"publisher","first-page":"160","DOI":"10.4103\/jcvjs.JCVJS_53_19","article-title":"The impact of osteotomy grade and location on regional and global alignment following CD surgery","volume":"10","author":"Passias PG","year":"2019","unstructured":"Passias PG, \nHorn SR, \nRaman T, \nBrown AE, \nLafage V, \nLafage R, \n\n \nThe impact of osteotomy grade and location on regional and global alignment following CD surgery. \nJ Craniovertebr Junction Spine. \n2019;\n10(\n3):\n160\u2013\n166.\n10.4103\/jcvjs.JCVJS_53_1931772428"},{"issue":"8","key":"b19","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1007\/s00586-017-5071-1","article-title":"Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients","volume":"26","author":"Smith JS","year":"2017","unstructured":"Smith JS, \nShaffrey CI, \nLafage R, \nLafage V, \nSchwab FJ, \nKim HJ, \n\n \nThree-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients. \nEur Spine J. \n2017;\n26(\n8):\n2128\u2013\n2137.\n10.1007\/s00586-017-5071-1"},{"issue":"1","key":"b20","series-title":"Ochsner J","first-page":"14","article-title":"Surgical treatment for adult spinal deformity: projected cost effectiveness at 5-year follow-up","volume":"14","author":"Terran J","year":"2014","unstructured":"Terran J, \nMcHugh BJ, \nFischer CR, \nLonner B, \nWarren D, \nGlassman S, \n\n \nSurgical treatment for adult spinal deformity: projected cost effectiveness at 5-year follow-up. \nOchsner J. \n2014;\n14(\n1):\n14\u2013\n22.\n24688328"},{"issue":"3","key":"b21","series-title":"Spine","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1097\/01.brs.0000197221.23109.fc","article-title":"Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention","volume":"31","author":"Lowe TG","year":"2006","unstructured":"Lowe TG, \nLenke L, \nBetz R, \nNewton P, \nClements D, \nHaher T, \n\n \nDistal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. \nSpine (Phila Pa 1976).\n2006;\n31(\n3):\n299\u2013\n302.\n10.1097\/01.brs.0000197221.23109.fc"},{"issue":"9","key":"b22","series-title":"Spine","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1097\/BRS.0000000000000844","article-title":"Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters","volume":"40","author":"Diebo BG","year":"2015","unstructured":"Diebo BG, \nFerrero E, \nLafage R, \nChallier V, \nLiabaud B, \nLiu S, \n\n \nRecruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. \nSpine (Phila Pa 1976).\n2015;\n40(\n9):\n642\u2013\n649.\n2570596210.1097\/BRS.0000000000000844"},{"issue":"3","key":"b23","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"252","DOI":"10.14444\/6034","article-title":"Suboptimal age-adjusted lumbo-pelvic mismatch predicts negative cervical-thoracic compensation in obese patients","volume":"13","author":"Horn SR","year":"2019","unstructured":"Horn SR, \nBortz CA, \nRamachandran S, \nPoorman GW, \nSegreto F, \nSiow M, \n\n \nSuboptimal age-adjusted lumbo-pelvic mismatch predicts negative cervical-thoracic compensation in obese patients. \nInt J Spine Surg. \n2019;\n13(\n3):\n252\u2013\n261.\n3132808910.14444\/6034"},{"issue":"5-6","key":"b24","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1007\/s00276-003-0154-6","article-title":"Variability of the spine and pelvis location with respect to the gravity line: a three-dimensional stereoradiographic study using a force platform","volume":"25","author":"Gangnet N","year":"2003","unstructured":"Gangnet N, \nPomero V, \nDumas R, \nSkalli W, \nVital JM\n. \nVariability of the spine and pelvis location with respect to the gravity line: a three-dimensional stereoradiographic study using a force platform. \nSurg Radiol Anat. \n2003;\n25(\n5-6):\n424\u2013\n433.\n10.1007\/s00276-003-0154-6"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/36\/4\/article-p616.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/36\/4\/article-p616.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/36\/4\/article-p616.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T01:02:44Z","timestamp":1751072564000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/36\/4\/article-p616.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":24,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2021.7.spine21306","relation":{},"ISSN":["1547-5654"],"issn-type":[{"type":"print","value":"1547-5654"}],"subject":[],"published":{"date-parts":[[2022,4,1]]}}}