{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T10:58:50Z","timestamp":1772103530146,"version":"3.50.1"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>There is currently no consensus regarding the appropriate lower instrumented vertebra (LIV) for multilevel posterior cervical fusion (PCF) constructs between C7 and crossing the cervicothoracic junction (CTJ). The goal of the present study was to compare postoperative sagittal alignment and functional outcomes among adult patients presenting with cervical myelopathy undergoing multilevel PCF terminating at C7 versus spanning the CTJ.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A single-institution retrospective analysis (January 2017\u2013December 2018) was performed of patients undergoing multilevel PCF for cervical myelopathy that involved the C6\u20137 vertebrae. Pre- and postoperative cervical spine radiographs were analyzed for cervical lordosis, cervical sagittal vertical axis (cSVA), and first thoracic (T1) vertebral slope (T1S) in two randomized independent trials. Modified Japanese Orthopaedic Association (mJOA) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were used to compare functional and patient-reported outcomes at the 12-month postoperative follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Sixty-six consecutive patients undergoing PCF and 53 age-matched controls were included in the study. There were 36 patients in the C7 LIV cohort and 30 patients in the LIV spanning the CTJ cohort. Despite significant correction, patients undergoing fusion remained less lordotic than asymptomatic controls, with a C2\u20137 Cobb angle of 17.7\u00b0 versus 25.5\u00b0 (p &lt; 0.001) and a T1S of 25.6\u00b0 versus 36.3\u00b0 (p &lt; 0.001). The CTJ cohort had superior alignment corrections in all radiographic parameters at the 12-month postoperative follow-up compared with the C7 cohort: increase in T1S (\u0394T1S 14.1\u00b0 vs 2.0\u00b0, p &lt; 0.001), increase in C2\u20137 lordosis (\u0394C2\u20137 lordosis 11.7\u00b0 vs 1.5\u00b0, p &lt; 0.001), and decrease in cSVA (\u0394cSVA 8.9 vs 5.0 mm, p &lt; 0.001). There were no differences in the mJOA motor and sensory scores between cohorts pre- and postoperatively. The C7 cohort reported significantly better PROMIS scores at 6 months (22.0 \u00b1 3.2 vs 11.5 \u00b1 0.5, p = 0.04) and 12 months (27.0 \u00b1 5.2 vs 13.5 \u00b1 0.9, p = 0.01) postoperatively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Crossing the CTJ may provide a greater cervical sagittal alignment correction in multilevel PCF surgeries. However, the improved alignment may not be associated with improved functional outcomes as measured by the mJOA scale. A new finding is that crossing the CTJ may be associated with worse patient-reported outcomes at 6 and 12 months of postoperative follow-up as measured by the PROMIS, which should be considered in surgical decision-making. Future prospective studies evaluating long-term radiographic, patient-reported, and functional outcomes are warranted.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.1.spine221013","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T12:30:32Z","timestamp":1677846632000},"page":"653-661","source":"Crossref","is-referenced-by-count":2,"title":["Crossing the cervicothoracic junction: an evaluation of radiographic alignment, functional outcomes, and patient-reported outcomes"],"prefix":"10.3171","volume":"38","author":[{"given":"Justin","family":"Aflatooni","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarthak","family":"Mohanty","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Angelov","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Hirase","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Bondar","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kakareka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Saucedo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Casper","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Comron","family":"Saifi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"23","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"E870","article-title":"Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine","volume":"33","author":"Miyazaki M","year":"2008","unstructured":"Miyazaki M, Hymanson HJ, Morishita Y,  Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. 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