{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:03:06Z","timestamp":1772827386303,"version":"3.50.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate whether level selection for a three-column osteotomy (3CO) impacts cervical deformity correction outcomes, including neurological, radiographic, and patient-reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review was performed of patients who underwent a cervical or upper thoracic 3CO for cervical deformity correction by the senior author from 2008 to 2024. Collected outcome measures included neurological outcomes, mechanical complication rates, spinopelvic alignment, and patient-reported outcomes. The minimum follow-up was 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>One hundred fifteen patients were identified who underwent a cervical or upper thoracic 3CO for cervical deformity correction, of whom 77 met inclusion criteria for this study with a minimum follow-up of 1 year. The median age was 66 years, the median BMI was 27, and 43% of patients were male. Sixteen patients underwent a 3CO at the C7\u2013T1 levels and 61 patients at T2\u20136 levels. Patients who underwent C7\u2013T1 3CO were more likely to experience a new postoperative neurological deficit compared with those who underwent T2\u20136 3CO (56% vs 18%, p = 0.004), had less correction in their T1 slope (6\u00b0 vs 18\u00b0, p = 0.027), had less correction in C2\u2013T4 sagittal vertical axis (2.8 cm vs 4.9 cm, p = 0.043), and had a worse Neck Disability Index (NDI) score at 1 year compared with baseline (an increase of 7 vs a decrease of 12, p = 0.033).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Cervical deformity patients who underwent a 3CO at C7\u2013T1 had a higher rate of postoperative neurological deficits, less radiographic correction, and worse NDI scores at 1 year compared with patients who underwent a 3CO from T2 to T6. Although 3CO level selection is multifactorial and patient specific, surgeons should consider a 3CO level caudal to T1 when feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.spine241538","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:47Z","timestamp":1757687687000},"page":"433-442","source":"Crossref","is-referenced-by-count":0,"title":["Cervical deformity correction: comparison of neurological, radiographic, and patient-reported outcome measures by three-column osteotomy level"],"prefix":"10.3171","volume":"43","author":[{"given":"Anthony L.","family":"Mikula","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Mazur-Hart","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexa M.","family":"Semonche","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winward","family":"Choy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas A.","family":"Wozny","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaemin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Cedars Sinai, Los Angeles, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron J.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurgery","first-page":"716","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, Line B, Bess S,  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. Neurosurgery. 2017;80(5):716\u2013725."},{"issue":"6","key":"b2","series-title":"J Neurosurg Spine","first-page":"855","article-title":"Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up","volume":"37","author":"Elias E","year":"2022","unstructured":"Elias E, Bess S, Line BG,  Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up. J Neurosurg Spine. 2022;37(6):855\u2013864."},{"issue":"2","key":"b3","series-title":"J Neurosurg Spine","first-page":"174","article-title":"Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases","volume":"15","author":"Deviren V","year":"2011","unstructured":"Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine. 2011;15(2):174\u2013181."},{"key":"b4","series-title":"Eur Spine J","first-page":"S23","article-title":"Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients","volume":"24 Suppl 1","author":"Theologis AA","year":"2015","unstructured":"Theologis AA, Tabaraee E, Funao H,  Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J. 2015;24 Suppl 1:S23-S30."},{"key":"b5","series-title":"Clin Orthop Relat Res","first-page":"132","article-title":"The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis","volume":"86","author":"Simmons EH","year":"1972","unstructured":"Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132\u2013143."},{"issue":"8","key":"b6","series-title":"Global Spine J","first-page":"2432","article-title":"Predicting mechanical failure following cervical deformity surgery: a composite score integrating age-adjusted cervical alignment targets","volume":"13","author":"Lafage R","year":"2023","unstructured":"Lafage R, Smith JS, Soroceanu A,  Predicting mechanical failure following cervical deformity surgery: a composite score integrating age-adjusted cervical alignment targets. Global Spine J. 2023;13(8):2432\u20132438."},{"issue":"5","key":"b7","series-title":"J Neurosurg Spine","first-page":"588","article-title":"Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up","volume":"33","author":"Smith JS","year":"2020","unstructured":"Smith JS, Buell TJ, Shaffrey CI,  Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up. 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J Manipulative Physiol Ther. 2014;37(3):190\u2013197."},{"issue":"11","key":"b13","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"1","key":"b14","series-title":"J Neurosurg Spine","first-page":"50","article-title":"Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes","volume":"32","author":"Mikula AL","year":"2019","unstructured":"Mikula AL, Puffer RC, Jeor JDS,  Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2019;32(1):50\u201355."},{"issue":"4","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"270","article-title":"Lower Hounsfield units at the upper instrumented vertebrae are significantly associated with proximal junctional kyphosis and failure near the thoracolumbar junction","volume":"21","author":"Mikula AL","year":"2021","unstructured":"Mikula AL, Fogelson JL, Lakomkin N,  Lower Hounsfield units at the upper instrumented vertebrae are significantly associated with proximal junctional kyphosis and failure near the thoracolumbar junction. Oper Neurosurg (Hagerstown). 2021;21(4):270\u2013275."},{"issue":"5","key":"b16","series-title":"J Neurosurg Spine","first-page":"694","article-title":"Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Lakomkin N, Pennington Z,  Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine. J Neurosurg Spine. 2022;37(5):694\u2013702."},{"issue":"3","key":"b17","series-title":"J Neurosurg Spine","first-page":"309","article-title":"Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients","volume":"41","author":"Mikula AL","year":"2024","unstructured":"Mikula AL, Lakomkin N, Hamouda AM,  Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients. J Neurosurg Spine. 2024;41(3):309\u2013315."},{"issue":"6","key":"b18","series-title":"J Neurosurg Spine","first-page":"673","article-title":"Reliability assessment of a novel cervical spine deformity classification system","volume":"23","author":"Ames CP","year":"2015","unstructured":"Ames CP, Smith JS, Eastlack R,  Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23(6):673\u2013683."},{"issue":"3","key":"b19","series-title":"J Neurosurg Spine","first-page":"297","article-title":"Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases","volume":"33","author":"Lau D","year":"2020","unstructured":"Lau D, Deviren V, Joshi RS, Ames CP. Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases. J Neurosurg Spine. 2020;33(3):297\u2013306."},{"issue":"3","key":"b20","series-title":"Neurospine","first-page":"525","article-title":"Three-column osteotomy for the treatment of rigid cervical deformity","volume":"17","author":"Lau D","year":"2020","unstructured":"Lau D, Ames CP. Three-column osteotomy for the treatment of rigid cervical deformity. Neurospine. 2020;17(3):525\u2013533."},{"issue":"3","key":"b21","series-title":"J Craniovertebr Junction Spine","first-page":"160","article-title":"The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery","volume":"10","author":"Passias PG","year":"2019","unstructured":"Passias PG, Horn SR, Raman T,  The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. J Craniovertebr Junction Spine. 2019;10(3):160\u2013166."},{"issue":"4","key":"b22","series-title":"J Neurosurg Spine","first-page":"441","article-title":"Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity","volume":"33","author":"Soroceanu A","year":"2020","unstructured":"Soroceanu A, Smith JS, Lau D,  Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity. J Neurosurg Spine. 2020;33(4):441\u2013445."},{"issue":"5","key":"b1","series-title":"Neurosurgery","first-page":"716","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, Line B, Bess S,  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. Neurosurgery. 2017;80(5):716\u2013725."},{"issue":"6","key":"b2","series-title":"J Neurosurg Spine","first-page":"855","article-title":"Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up","volume":"37","author":"Elias E","year":"2022","unstructured":"Elias E, Bess S, Line BG,  Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up. J Neurosurg Spine. 2022;37(6):855\u2013864."},{"issue":"2","key":"b3","series-title":"J Neurosurg Spine","first-page":"174","article-title":"Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases","volume":"15","author":"Deviren V","year":"2011","unstructured":"Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine. 2011;15(2):174\u2013181."},{"key":"b4","series-title":"Eur Spine J","first-page":"S23","article-title":"Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients","volume":"24 Suppl 1","author":"Theologis AA","year":"2015","unstructured":"Theologis AA, Tabaraee E, Funao H,  Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J. 2015;24 Suppl 1:S23-S30."},{"key":"b5","series-title":"Clin Orthop Relat Res","first-page":"132","article-title":"The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis","volume":"86","author":"Simmons EH","year":"1972","unstructured":"Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132\u2013143."},{"issue":"8","key":"b6","series-title":"Global Spine J","first-page":"2432","article-title":"Predicting mechanical failure following cervical deformity surgery: a composite score integrating age-adjusted cervical alignment targets","volume":"13","author":"Lafage R","year":"2023","unstructured":"Lafage R, Smith JS, Soroceanu A,  Predicting mechanical failure following cervical deformity surgery: a composite score integrating age-adjusted cervical alignment targets. Global Spine J. 2023;13(8):2432\u20132438."},{"issue":"5","key":"b7","series-title":"J Neurosurg Spine","first-page":"588","article-title":"Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up","volume":"33","author":"Smith JS","year":"2020","unstructured":"Smith JS, Buell TJ, Shaffrey CI,  Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up. J Neurosurg Spine. 2020;33(5):588\u2013600."},{"issue":"8","key":"b8","series-title":"Eur Spine J","first-page":"2128","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, Shaffrey CI, Lafage R,  Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients. Eur Spine J. 2017;26(8):2128\u20132137."},{"key":"b9","series-title":"World Neurosurg","first-page":"228","article-title":"Assessment of surgical treatment strategies for moderate to severe cervical spinal deformity reveals marked variation in approaches, osteotomies, and fusion levels","volume":"91","author":"Smith JS","year":"2016","unstructured":"Smith JS, Klineberg E, Shaffrey CI,  Assessment of surgical treatment strategies for moderate to severe cervical spinal deformity reveals marked variation in approaches, osteotomies, and fusion levels. World Neurosurg. 2016;91:228\u2013237."},{"issue":"4","key":"b10","series-title":"Global Spine J","first-page":"1914","article-title":"Paraspinal sarcopenia and lower Hounsfield units are independent predictors of increased risk for proximal junctional complications following thoracolumbar fusions terminating in the upper thoracic spine","volume":"15","author":"Pinter ZW","year":"2025","unstructured":"Pinter ZW, Bernatz J, Mikula AL,  Paraspinal sarcopenia and lower Hounsfield units are independent predictors of increased risk for proximal junctional complications following thoracolumbar fusions terminating in the upper thoracic spine. Global Spine J. 2025;15(4):1914\u20131923."},{"issue":"6","key":"b11","series-title":"Global Spine J","first-page":"931","article-title":"Higher paraspinal muscle density effect on outcomes after anterior cervical discectomy and fusion","volume":"11","author":"Pinter ZW","year":"2021","unstructured":"Pinter ZW, Wagner SC, Fredericks DR,  Higher paraspinal muscle density effect on outcomes after anterior cervical discectomy and fusion. Global Spine J. 2021;11(6):931\u2013935."},{"issue":"3","key":"b12","series-title":"J Manipulative Physiol Ther","first-page":"190","article-title":"Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging","volume":"37","author":"Battaglia PJ","year":"2014","unstructured":"Battaglia PJ, Maeda Y, Welk A, Hough B, Kettner N. Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manipulative Physiol Ther. 2014;37(3):190\u2013197."},{"issue":"11","key":"b13","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"1","key":"b14","series-title":"J Neurosurg Spine","first-page":"50","article-title":"Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes","volume":"32","author":"Mikula AL","year":"2019","unstructured":"Mikula AL, Puffer RC, Jeor JDS,  Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes. J Neurosurg Spine. 2019;32(1):50\u201355."},{"issue":"4","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"270","article-title":"Lower Hounsfield units at the upper instrumented vertebrae are significantly associated with proximal junctional kyphosis and failure near the thoracolumbar junction","volume":"21","author":"Mikula AL","year":"2021","unstructured":"Mikula AL, Fogelson JL, Lakomkin N,  Lower Hounsfield units at the upper instrumented vertebrae are significantly associated with proximal junctional kyphosis and failure near the thoracolumbar junction. Oper Neurosurg (Hagerstown). 2021;21(4):270\u2013275."},{"issue":"5","key":"b16","series-title":"J Neurosurg Spine","first-page":"694","article-title":"Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Lakomkin N, Pennington Z,  Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine. J Neurosurg Spine. 2022;37(5):694\u2013702."},{"issue":"3","key":"b17","series-title":"J Neurosurg Spine","first-page":"309","article-title":"Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients","volume":"41","author":"Mikula AL","year":"2024","unstructured":"Mikula AL, Lakomkin N, Hamouda AM,  Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients. J Neurosurg Spine. 2024;41(3):309\u2013315."},{"issue":"6","key":"b18","series-title":"J Neurosurg Spine","first-page":"673","article-title":"Reliability assessment of a novel cervical spine deformity classification system","volume":"23","author":"Ames CP","year":"2015","unstructured":"Ames CP, Smith JS, Eastlack R,  Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23(6):673\u2013683."},{"issue":"3","key":"b19","series-title":"J Neurosurg Spine","first-page":"297","article-title":"Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases","volume":"33","author":"Lau D","year":"2020","unstructured":"Lau D, Deviren V, Joshi RS, Ames CP. Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases. J Neurosurg Spine. 2020;33(3):297\u2013306."},{"issue":"3","key":"b20","series-title":"Neurospine","first-page":"525","article-title":"Three-column osteotomy for the treatment of rigid cervical deformity","volume":"17","author":"Lau D","year":"2020","unstructured":"Lau D, Ames CP. Three-column osteotomy for the treatment of rigid cervical deformity. Neurospine. 2020;17(3):525\u2013533."},{"issue":"3","key":"b21","series-title":"J Craniovertebr Junction Spine","first-page":"160","article-title":"The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery","volume":"10","author":"Passias PG","year":"2019","unstructured":"Passias PG, Horn SR, Raman T,  The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. 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