{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T04:04:17Z","timestamp":1784952257282,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Cervical instability may influence the development and progression of cervical spondylotic myelopathy (CSM). This study aimed to investigate the prevalence of cervical instability in patients with CSM and identify associated factors.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors examined the clinical and radiological characteristics of 167 patients aged 40\u201380 years diagnosed with CSM who required hospitalization between June 2022 and June 2024. Cervical spine radiography was used to evaluate cervical instability, which was defined as a \u2265 3-mm translational motion between adjacent vertebrae on flexion-extension views. Factors potentially associated with cervical instability were compared between patients with and without instability and further investigated using multivariate logistic regression.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The mean patient age was 57.7 \u00b1 10.3 years, and 115 patients (68.9%) were men. Cervical instability was identified in 72 patients (43.1%). Multivariate logistic regression identified cervical facet joint degeneration, a difference between the T1 slope and cervical lordosis, and visual analog scale score for neck pain as significantly associated factors for cervical instability.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study revealed a high prevalence (43.1%) of cervical instability among patients with CSM and identified significantly associated factors. Spine surgeons should pay special attention to these factors in the surgical decision-making process.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.1.spine241183","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T22:32:02Z","timestamp":1744410722000},"page":"673-678","source":"Crossref","is-referenced-by-count":5,"title":["Factors associated with cervical instability in cervical myelopathy patients"],"prefix":"10.3171","volume":"42","author":[{"given":"Chao","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiyu","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longtao","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranlyu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunde","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"BMJ","first-page":"k186","article-title":"Degenerative cervical myelopathy","volume":"360","author":"Davies BM","year":"2018","unstructured":"Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018;360:k186."},{"issue":"2","key":"b2","series-title":"N Engl J Med","first-page":"159","article-title":"Degenerative cervical spondylosis","volume":"383","author":"Theodore N","year":"2020","unstructured":"Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383(2):159\u2013168."},{"issue":"4","key":"b3","series-title":"Spine J","first-page":"571","article-title":"Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy","volume":"21","author":"Lopez WY","year":"2021","unstructured":"Lopez WY, Goh BC, Upadhyaya S, Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy. Spine J. 2021;21(4):571\u2013577."},{"issue":"2","key":"b4","series-title":"Nat Rev Neurol","first-page":"108","article-title":"Degenerative cervical myelopathy\u2014update and future directions","volume":"16","author":"Badhiwala JH","year":"2020","unstructured":"Badhiwala JH, Ahuja CS, Akbar MA, Degenerative cervical myelopathy\u2014update and future directions. Nat Rev Neurol. 2020;16(2):108\u2013124."},{"issue":"4","key":"b5","series-title":"Am J Med","first-page":"435","article-title":"Cervical myelopathy: diagnosis, contemporary treatment, and outcomes","volume":"135","author":"Zhang AS","year":"2022","unstructured":"Zhang AS, Myers C, McDonald CL, Alsoof D, Anderson G, Daniels AH. Cervical myelopathy: diagnosis, contemporary treatment, and outcomes. Am J Med. 2022;135(4):435\u2013443."},{"issue":"6","key":"b6","series-title":"Neurosurgery","first-page":"1259","article-title":"Comparison of clinical outcomes of cervical laminoplasty for cervical spondylotic myelopathy: double-door with lamina staple, single-door with miniplate, and double-door with spacer-a 2-year follow-up study","volume":"92","author":"Li C","year":"2023","unstructured":"Li C, Wang Z, Tang J, Comparison of clinical outcomes of cervical laminoplasty for cervical spondylotic myelopathy: double-door with lamina staple, single-door with miniplate, and double-door with spacer-a 2-year follow-up study. Neurosurgery. 2023;92(6):1259\u20131268."},{"issue":"7","key":"b7","series-title":"Med Phys","first-page":"4182","article-title":"Application of TVD-Net for sagittal alignment and instability measurements in cervical spine radiographs","volume":"50","author":"Xiao Q","year":"2023","unstructured":"Xiao Q, Chen Y, Wang J, Application of TVD-Net for sagittal alignment and instability measurements in cervical spine radiographs. Med Phys. 2023;50(7):4182\u20134196."},{"issue":"12","key":"b8","series-title":"Phys Ther","first-page":"1686","article-title":"Diagnostic accuracy of upper cervical spine instability tests: a systematic review","volume":"93","author":"Hutting N","year":"2013","unstructured":"Hutting N, Scholten-Peeters GG, Vijverman V, Keesenberg MD, Verhagen AP. Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Phys Ther. 2013;93(12):1686\u20131695."},{"issue":"2","key":"b9","series-title":"Curr Opin Rheumatol","first-page":"114","article-title":"Current management of cervical spine instability","volume":"7","author":"Garfin SR","year":"1995","unstructured":"Garfin SR, Ahlgren BD. Current management of cervical spine instability. Curr Opin Rheumatol. 1995;7(2):114\u2013119."},{"issue":"12","key":"b10","series-title":"Orthopade","first-page":"977","article-title":"Cervical instability in cervical spondylosis patients: significance of the radiographic index method for evaluation","volume":"47","author":"Alizada M","year":"2018","unstructured":"Alizada M, Li RR, Hayatullah G. Cervical instability in cervical spondylosis patients: significance of the radiographic index method for evaluation. Orthopade. 2018;47(12):977\u2013985."},{"issue":"11","key":"b11","series-title":"Spine J","first-page":"1837","article-title":"Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy","volume":"22","author":"Obo T","year":"2022","unstructured":"Obo T, Fujishiro T, Mizutani M, Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy. Spine J. 2022;22(11):1837\u20131847."},{"issue":"1","key":"b12","series-title":"Eur Spine J","first-page":"85","article-title":"Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up","volume":"26","author":"Blizzard DJ","year":"2017","unstructured":"Blizzard DJ, Caputo AM, Sheets CZ, Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up. Eur Spine J. 2017;26(1):85\u201393."},{"issue":"9596","key":"b13","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"2","key":"b14","series-title":"Neurospine","first-page":"393","article-title":"Prevalence and clinical impact of cervical facet joint degeneration on degenerative cervical myelopathy: a novel computed tomography classification study","volume":"19","author":"Okamoto A","year":"2022","unstructured":"Okamoto A, Takeshima Y, Yokoyama S, Prevalence and clinical impact of cervical facet joint degeneration on degenerative cervical myelopathy: a novel computed tomography classification study. Neurospine. 2022;19(2):393\u2013401."},{"key":"b15","series-title":"BMJ","first-page":"j3221","article-title":"Advances in the diagnosis and management of neck pain","volume":"358","author":"Cohen SP","year":"2017","unstructured":"Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221."},{"issue":"1","key":"b16","series-title":"Pain Ther","first-page":"143","article-title":"Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review","volume":"10","author":"Peng B","year":"2021","unstructured":"Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review. Pain Ther. 2021;10(1):143\u2013164."},{"issue":"3","key":"b17","series-title":"Neurosurgery","first-page":"446","article-title":"A new piece of the puzzle to understand cervical sagittal alignment: utilizing a novel angle \u03b4 to describe the relationship among T1 vertebral body slope, cervical lordosis, and cervical sagittal alignment","volume":"86","author":"Goldschmidt E","year":"2020","unstructured":"Goldschmidt E, Angriman F, Agarwal N, A new piece of the puzzle to understand cervical sagittal alignment: utilizing a novel angle \u03b4 to describe the relationship among T1 vertebral body slope, cervical lordosis, and cervical sagittal alignment. Neurosurgery. 2020;86(3):446\u2013451."},{"issue":"1","key":"b18","series-title":"J Neurosurg Spine","first-page":"31","article-title":"Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis","volume":"30","author":"Staub BN","year":"2018","unstructured":"Staub BN, Lafage R, Kim HJ, Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis. J Neurosurg Spine. 2018;30(1):31\u201337."},{"issue":"9","key":"b19","series-title":"Eur Spine J","first-page":"2434","article-title":"The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study","volume":"30","author":"Tao Y","year":"2021","unstructured":"Tao Y, Galbusera F, Niemeyer F, The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. Eur Spine J. 2021;30(9):2434\u20132442."},{"issue":"12","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"E713","article-title":"Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients","volume":"39","author":"Park MS","year":"2014","unstructured":"Park MS, Lee YB, Moon SH, Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients. Spine (Phila Pa 1976). 2014;39(12):E713\u2013E718."},{"issue":"12","key":"b21","series-title":"Spine J","first-page":"2232","article-title":"Cervical facet joint degeneration, facet joint angle, and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4\/5: a propensity score-matched study","volume":"24","author":"Wu Y","year":"2024","unstructured":"Wu Y, Wu J, Qin T, Cervical facet joint degeneration, facet joint angle, and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4\/5: a propensity score-matched study. Spine J. 2024;24(12):2232\u20132242."},{"key":"b22","series-title":"World Neurosurg","first-page":"e361","article-title":"Endplate and facet joint changes in cervical spondylotic myelopathy","volume":"175","author":"ElFiky T","year":"2023","unstructured":"ElFiky T, Bessada B, Stienen MN, Siam AE, Hasan A. Endplate and facet joint changes in cervical spondylotic myelopathy. World Neurosurg. 2023;175:e361\u2013e366."},{"issue":"2","key":"b23","series-title":"Neurospine","first-page":"443","article-title":"Relationship between endplate defects, Modic change, facet joint degeneration, and disc degeneration of cervical spine","volume":"17","author":"Lee SH","year":"2020","unstructured":"Lee SH, Son DW, Lee JS, Sung SK, Lee SW, Song GS. Relationship between endplate defects, Modic change, facet joint degeneration, and disc degeneration of cervical spine. Neurospine. 2020;17(2):443\u2013452."},{"key":"b1","series-title":"BMJ","first-page":"k186","article-title":"Degenerative cervical myelopathy","volume":"360","author":"Davies BM","year":"2018","unstructured":"Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018;360:k186."},{"issue":"2","key":"b2","series-title":"N Engl J Med","first-page":"159","article-title":"Degenerative cervical spondylosis","volume":"383","author":"Theodore N","year":"2020","unstructured":"Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383(2):159\u2013168."},{"issue":"4","key":"b3","series-title":"Spine J","first-page":"571","article-title":"Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy","volume":"21","author":"Lopez WY","year":"2021","unstructured":"Lopez WY, Goh BC, Upadhyaya S, Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy. Spine J. 2021;21(4):571\u2013577."},{"issue":"2","key":"b4","series-title":"Nat Rev Neurol","first-page":"108","article-title":"Degenerative cervical myelopathy\u2014update and future directions","volume":"16","author":"Badhiwala JH","year":"2020","unstructured":"Badhiwala JH, Ahuja CS, Akbar MA, Degenerative cervical myelopathy\u2014update and future directions. Nat Rev Neurol. 2020;16(2):108\u2013124."},{"issue":"4","key":"b5","series-title":"Am J Med","first-page":"435","article-title":"Cervical myelopathy: diagnosis, contemporary treatment, and outcomes","volume":"135","author":"Zhang AS","year":"2022","unstructured":"Zhang AS, Myers C, McDonald CL, Alsoof D, Anderson G, Daniels AH. Cervical myelopathy: diagnosis, contemporary treatment, and outcomes. Am J Med. 2022;135(4):435\u2013443."},{"issue":"6","key":"b6","series-title":"Neurosurgery","first-page":"1259","article-title":"Comparison of clinical outcomes of cervical laminoplasty for cervical spondylotic myelopathy: double-door with lamina staple, single-door with miniplate, and double-door with spacer-a 2-year follow-up study","volume":"92","author":"Li C","year":"2023","unstructured":"Li C, Wang Z, Tang J, Comparison of clinical outcomes of cervical laminoplasty for cervical spondylotic myelopathy: double-door with lamina staple, single-door with miniplate, and double-door with spacer-a 2-year follow-up study. Neurosurgery. 2023;92(6):1259\u20131268."},{"issue":"7","key":"b7","series-title":"Med Phys","first-page":"4182","article-title":"Application of TVD-Net for sagittal alignment and instability measurements in cervical spine radiographs","volume":"50","author":"Xiao Q","year":"2023","unstructured":"Xiao Q, Chen Y, Wang J, Application of TVD-Net for sagittal alignment and instability measurements in cervical spine radiographs. Med Phys. 2023;50(7):4182\u20134196."},{"issue":"12","key":"b8","series-title":"Phys Ther","first-page":"1686","article-title":"Diagnostic accuracy of upper cervical spine instability tests: a systematic review","volume":"93","author":"Hutting N","year":"2013","unstructured":"Hutting N, Scholten-Peeters GG, Vijverman V, Keesenberg MD, Verhagen AP. Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Phys Ther. 2013;93(12):1686\u20131695."},{"issue":"2","key":"b9","series-title":"Curr Opin Rheumatol","first-page":"114","article-title":"Current management of cervical spine instability","volume":"7","author":"Garfin SR","year":"1995","unstructured":"Garfin SR, Ahlgren BD. Current management of cervical spine instability. Curr Opin Rheumatol. 1995;7(2):114\u2013119."},{"issue":"12","key":"b10","series-title":"Orthopade","first-page":"977","article-title":"Cervical instability in cervical spondylosis patients: significance of the radiographic index method for evaluation","volume":"47","author":"Alizada M","year":"2018","unstructured":"Alizada M, Li RR, Hayatullah G. Cervical instability in cervical spondylosis patients: significance of the radiographic index method for evaluation. Orthopade. 2018;47(12):977\u2013985."},{"issue":"11","key":"b11","series-title":"Spine J","first-page":"1837","article-title":"Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy","volume":"22","author":"Obo T","year":"2022","unstructured":"Obo T, Fujishiro T, Mizutani M, Segmental cervical instability does not drive the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy. Spine J. 2022;22(11):1837\u20131847."},{"issue":"1","key":"b12","series-title":"Eur Spine J","first-page":"85","article-title":"Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up","volume":"26","author":"Blizzard DJ","year":"2017","unstructured":"Blizzard DJ, Caputo AM, Sheets CZ, Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up. Eur Spine J. 2017;26(1):85\u201393."},{"issue":"9596","key":"b13","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"2","key":"b14","series-title":"Neurospine","first-page":"393","article-title":"Prevalence and clinical impact of cervical facet joint degeneration on degenerative cervical myelopathy: a novel computed tomography classification study","volume":"19","author":"Okamoto A","year":"2022","unstructured":"Okamoto A, Takeshima Y, Yokoyama S, Prevalence and clinical impact of cervical facet joint degeneration on degenerative cervical myelopathy: a novel computed tomography classification study. Neurospine. 2022;19(2):393\u2013401."},{"key":"b15","series-title":"BMJ","first-page":"j3221","article-title":"Advances in the diagnosis and management of neck pain","volume":"358","author":"Cohen SP","year":"2017","unstructured":"Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221."},{"issue":"1","key":"b16","series-title":"Pain Ther","first-page":"143","article-title":"Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review","volume":"10","author":"Peng B","year":"2021","unstructured":"Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review. Pain Ther. 2021;10(1):143\u2013164."},{"issue":"3","key":"b17","series-title":"Neurosurgery","first-page":"446","article-title":"A new piece of the puzzle to understand cervical sagittal alignment: utilizing a novel angle \u03b4 to describe the relationship among T1 vertebral body slope, cervical lordosis, and cervical sagittal alignment","volume":"86","author":"Goldschmidt E","year":"2020","unstructured":"Goldschmidt E, Angriman F, Agarwal N, A new piece of the puzzle to understand cervical sagittal alignment: utilizing a novel angle \u03b4 to describe the relationship among T1 vertebral body slope, cervical lordosis, and cervical sagittal alignment. Neurosurgery. 2020;86(3):446\u2013451."},{"issue":"1","key":"b18","series-title":"J Neurosurg Spine","first-page":"31","article-title":"Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis","volume":"30","author":"Staub BN","year":"2018","unstructured":"Staub BN, Lafage R, Kim HJ, Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis. J Neurosurg Spine. 2018;30(1):31\u201337."},{"issue":"9","key":"b19","series-title":"Eur Spine J","first-page":"2434","article-title":"The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study","volume":"30","author":"Tao Y","year":"2021","unstructured":"Tao Y, Galbusera F, Niemeyer F, The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. Eur Spine J. 2021;30(9):2434\u20132442."},{"issue":"12","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"E713","article-title":"Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients","volume":"39","author":"Park MS","year":"2014","unstructured":"Park MS, Lee YB, Moon SH, Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients. Spine (Phila Pa 1976). 2014;39(12):E713\u2013E718."},{"issue":"12","key":"b21","series-title":"Spine J","first-page":"2232","article-title":"Cervical facet joint degeneration, facet joint angle, and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4\/5: a propensity score-matched study","volume":"24","author":"Wu Y","year":"2024","unstructured":"Wu Y, Wu J, Qin T, Cervical facet joint degeneration, facet joint angle, and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4\/5: a propensity score-matched study. Spine J. 2024;24(12):2232\u20132242."},{"key":"b22","series-title":"World Neurosurg","first-page":"e361","article-title":"Endplate and facet joint changes in cervical spondylotic myelopathy","volume":"175","author":"ElFiky T","year":"2023","unstructured":"ElFiky T, Bessada B, Stienen MN, Siam AE, Hasan A. Endplate and facet joint changes in cervical spondylotic myelopathy. World Neurosurg. 2023;175:e361\u2013e366."},{"issue":"2","key":"b23","series-title":"Neurospine","first-page":"443","article-title":"Relationship between endplate defects, Modic change, facet joint degeneration, and disc degeneration of cervical spine","volume":"17","author":"Lee SH","year":"2020","unstructured":"Lee SH, Son DW, Lee JS, Sung SK, Lee SW, Song GS. Relationship between endplate defects, Modic change, facet joint degeneration, and disc degeneration of cervical spine. Neurospine. 2020;17(2):443\u2013452."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/6\/article-p673.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/6\/article-p673.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/6\/article-p673.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:45:40Z","timestamp":1772804740000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/6\/article-p673.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,1]]},"references-count":46,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.1.spine241183","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,6,1]]}}}