{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:56:00Z","timestamp":1784937360839,"version":"3.55.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The C2 slope (C2S) is one of the parameters that can determine cervical sagittal alignment, but its clinical significance is relatively unexplored. This study aimed to evaluate the clinical significance of the C2S after multilevel cervical spine fusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A total of 111 patients who underwent multilevel cervical spine fusion were included in this study. The C2S, cervical sagittal vertical axis (cSVA), C2\u20137 lordosis, and T1 slope (T1S) were measured in standing lateral cervical spine radiographs preoperatively and 2 years after the surgery. Clinical outcome measures were visual analog scale (VAS) neck and arm pain scores, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and patient-reported subjective improvement rate (IR) percentage. Statistical analysis was performed using a paired-samples t-test and Pearson\u2019s correlation, and a receiver operating characteristic (ROC) curve to determine the cutoff values of C2S.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>C2S demonstrated a significant correlation with the cSVA, C2\u20137 lordosis, T1S, and T1S minus cervical lordosis. C2S revealed a significant correlation with the JOA, neck pain VAS, and NDI scores at 2 years after surgery. Change in the C2S correlated with postoperative neck pain and NDI scores. ROC curves demonstrated the cutoff values of C2S as 18.8\u00b0, 22.25\u00b0, and 25.35\u00b0, according to a cSVA of 40 mm, severe disability expressed by NDI, and severe myelopathy, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>C2S can be an additional cervical sagittal alignment parameter that can be a useful prognostic factor after multilevel cervical spine fusion.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.6.spine22588","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T08:36:10Z","timestamp":1660898170000},"page":"24-30","source":"Crossref","is-referenced-by-count":10,"title":["Clinical significance of the C2 slope after multilevel cervical spine fusion"],"prefix":"10.3171","volume":"38","author":[{"given":"Namhoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"},{"name":"Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Soo","family":"Suk","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Won","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joonoh","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunjin","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Hwan","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hak-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwan-Mo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1227\/NEU.0b013e31826100c9","article-title":"The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery","volume":"71","author":"Tang JA","year":"2012","unstructured":"Tang JA, Scheer JK, Smith JS,  The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. 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