{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:57Z","timestamp":1776096417614,"version":"3.50.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Correcting sagittal alignment is important in surgery for adult spinal deformity (ASD) surgery. T1 slope (TS) is a key parameter for evaluating whole spine alignment. Many patients with a large TS have thoracolumbar and cervical spine deformities. The aim of this study was to compare alignment changes before and after ASD surgery in two groups categorized by a preoperative TS of \u2265 40\u00b0 or < 40\u00b0.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors included patients aged \u2265 40 years who underwent spinal correction surgery for ASD between 2010 and 2019 and had at least 5 years of follow-up. The patients were divided into two groups: the high TS group (group H, TS \u2265 40\u00b0) and the low TS group (group L, TS < 40\u00b0). Radiographic parameters and patient-reported outcome measures (PROMs) such as the Scoliosis Research Society\u201322 and Oswestry Disability Index were assessed preoperatively, postoperatively, and at the 2- and 5-year follow-ups.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n There were 57 patients in group H and 161 in group L. Patients in group H had a higher upper instrumented vertebra (mean 8.1 vs 9.8, p < 0.001). Postoperative TS was reduced in both groups (mean 32.7\u00b0 vs 24.2\u00b0). The sagittal vertical axis (SVA) improved in both groups immediately after surgery (51.9 mm vs 37.3 mm) but was higher in group H at 5 years (mean 85.3 mm vs 62.2 mm, p < 0.001). Thoracic kyphosis (TK) increased in both groups but remained significantly higher in group H (mean 38.2\u00b0 to 46.2\u00b0) than in group L (mean 32.8\u00b0 to 39.4\u00b0) (p < 0.001). The C2\u20137 SVA worsened in group H (18.5 mm to 31.4 mm) compared with group L (14.4 mm to 20.1 mm) (p < 0.001). Proximal junctional kyphosis (PJK) was more frequent in group H (36.8% vs 18.0%, p = 0.0058).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In ASD patients with TS \u2265 40\u00b0, initial alignment improvement was followed by significant deterioration in nonfused segments at 5 years. While PROMs showed no differences between the groups, higher PJK incidence warrants careful monitoring.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.spine25400","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:11:56Z","timestamp":1770829916000},"page":"554-563","source":"Crossref","is-referenced-by-count":0,"title":["Deteriorating alignment in the nonfused vertebrae 5 years after surgery in patients with a T1 slope \u2265 40\u00b0"],"prefix":"10.3171","volume":"44","author":[{"given":"Yusuke","family":"Murakami","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"},{"name":"Department of Orthopaedic Surgery, Ehime University School of Medicine, Toon City, Ehime;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin","family":"Oe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"},{"name":"Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Yamato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiko","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"},{"name":"Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Go","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Banno","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"},{"name":"Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideyuki","family":"Arima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Ide","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenta","family":"Kurosu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiro","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10193","key":"b1","series-title":"Lancet","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O, Adult spinal deformity. Lancet. 2019;394(10193):160\u2013172."},{"issue":"6","key":"b2","series-title":"J Neurosurg Spine","first-page":"751","article-title":"Economic burden of nonoperative treatment of adult spinal deformity","volume":"39","author":"Passias PG","year":"2023","unstructured":"Passias PG, Ahmad W, Dave P, Economic burden of nonoperative treatment of adult spinal deformity. J Neurosurg Spine. 2023;39(6):751\u2013756."},{"issue":"4","key":"b3","series-title":"Neurosurg Clin N Am","first-page":"527","article-title":"Preoperative planning for adult spinal deformity goals: level selection and alignment goals","volume":"34","author":"Dalton J","year":"2023","unstructured":"Dalton J, Mohamed A, Akioyamen N, Schwab FJ, Lafage V. Preoperative planning for adult spinal deformity goals: level selection and alignment goals. Neurosurg Clin N Am. 2023;34(4):527\u2013536."},{"issue":"19","key":"b4","series-title":"J Bone Joint Surg Am","first-page":"1661","article-title":"Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery","volume":"99","author":"Yilgor C","year":"2017","unstructured":"Yilgor C, Sogunmez N, Boissiere L, Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99(19):1661\u20131672."},{"issue":"1","key":"b5","series-title":"Spine Deform","first-page":"121","article-title":"Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications","volume":"10","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Elysee J, Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. Spine Deform. 2022;10(1):121\u2013131."},{"issue":"5","key":"b6","series-title":"JBJS Rev","first-page":"e2","article-title":"Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review","volume":"6","author":"Iyer S","year":"2018","unstructured":"Iyer S, Sheha E, Fu MC, Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review. JBJS Rev. 2018;6(5):e2."},{"issue":"11","key":"b7","series-title":"Spine J","first-page":"994","article-title":"The use of the T1 sagittal angle in predicting overall sagittal balance of the spine","volume":"10","author":"Knott PT","year":"2010","unstructured":"Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J. 2010;10(11):994\u2013998."},{"issue":"3","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"185","article-title":"Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI","volume":"41","author":"Weng C","year":"2016","unstructured":"Weng C, Wang J, Tuchman A, Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976). 2016;41(3):185\u2013190."},{"issue":"1","key":"b9","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":"2019","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. 2019;30(1):31\u201337."},{"issue":"6","key":"b10","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."},{"key":"b11","series-title":"Adv Orthop","first-page":"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, Schwab F, Ames C, Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment. Adv Orthop. 2011;2011:415946."},{"issue":"3","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"E180","article-title":"Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis","volume":"37","author":"Lafage V","year":"2012","unstructured":"Lafage V, Ames C, Schwab F, Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine (Phila Pa 1976). 2012;37(3):E180\u2013E187."},{"issue":"19","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"1487","article-title":"The influence of age and sex on cervical spinal alignment among volunteers aged over 50","volume":"40","author":"Oe S","year":"2015","unstructured":"Oe S, Togawa D, Nakai K, The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine (Phila Pa 1976). 2015;40(19):1487\u20131494."},{"issue":"19","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"E1168","article-title":"Preoperative T1 slope more than 40 degrees as a risk factor of correction loss in patients with adult spinal deformity","volume":"41","author":"Oe S","year":"2016","unstructured":"Oe S, Yamato Y, Togawa D, Preoperative T1 slope more than 40 degrees as a risk factor of correction loss in patients with adult spinal deformity. Spine (Phila Pa 1976). 2016;41(19):E1168\u2013E1176."},{"issue":"11","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"829","article-title":"Results of the 2014 SRS Survey on PJK\/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development","volume":"40","author":"Scheer JK","year":"2015","unstructured":"Scheer JK, Fakurnejad S, Lau D, Results of the 2014 SRS Survey on PJK\/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development. Spine (Phila Pa 1976). 2015;40(11):829\u2013840."},{"issue":"6","key":"b16","series-title":"J Clin Med","first-page":"1586","article-title":"Conditions for achieving postoperative pelvic incidence-lumbar lordosis < 10 degrees in circumferential minimally invasive surgery for adult spinal deformity","volume":"11","author":"Ishihara M","year":"2022","unstructured":"Ishihara M, Taniguchi S, Adachi T, Conditions for achieving postoperative pelvic incidence-lumbar lordosis < 10 degrees in circumferential minimally invasive surgery for adult spinal deformity. J Clin Med. 2022;11(6):1586."},{"issue":"17","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"E1001","article-title":"Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity","volume":"39","author":"Smith JS","year":"2014","unstructured":"Smith JS, Lafage V, Schwab FJ, Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976). 2014;39(17):E1001\u2013E1009."},{"issue":"4","key":"b18","series-title":"Neurosurgery","first-page":"675","article-title":"Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity","volume":"83","author":"Passias PG","year":"2018","unstructured":"Passias PG, Horn SR, Jalai CM, Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity. Neurosurgery. 2018;83(4):675\u2013682."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"830","article-title":"Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformity: a 3-year radiographic analysis","volume":"34","author":"Passias PG","year":"2021","unstructured":"Passias PG, Alas H, Naessig S, Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformity: a 3-year radiographic analysis. J Neurosurg Spine. 2021;34(6):830\u2013838."},{"issue":"6","key":"b20","series-title":"J Neurosurg Spine","first-page":"742","article-title":"The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity","volume":"39","author":"Passfall L","year":"2023","unstructured":"Passfall L, Imbo B, Lafage V, The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity. J Neurosurg Spine. 2023;39(6):742\u2013750."},{"issue":"8","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"579","article-title":"Comparison of postoperative outcomes according to compensatory changes of the thoracic spine among patients with a T1 slope more than 40\u00b0","volume":"44","author":"Oe S","year":"2019","unstructured":"Oe S, Togawa D, Yamato Y, Comparison of postoperative outcomes according to compensatory changes of the thoracic spine among patients with a T1 slope more than 40\u00b0. Spine (Phila Pa 1976). 2019;44(8):579\u2013587."},{"issue":"10193","key":"b1","series-title":"Lancet","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O, Adult spinal deformity. Lancet. 2019;394(10193):160\u2013172."},{"issue":"6","key":"b2","series-title":"J Neurosurg Spine","first-page":"751","article-title":"Economic burden of nonoperative treatment of adult spinal deformity","volume":"39","author":"Passias PG","year":"2023","unstructured":"Passias PG, Ahmad W, Dave P, Economic burden of nonoperative treatment of adult spinal deformity. J Neurosurg Spine. 2023;39(6):751\u2013756."},{"issue":"4","key":"b3","series-title":"Neurosurg Clin N Am","first-page":"527","article-title":"Preoperative planning for adult spinal deformity goals: level selection and alignment goals","volume":"34","author":"Dalton J","year":"2023","unstructured":"Dalton J, Mohamed A, Akioyamen N, Schwab FJ, Lafage V. Preoperative planning for adult spinal deformity goals: level selection and alignment goals. Neurosurg Clin N Am. 2023;34(4):527\u2013536."},{"issue":"19","key":"b4","series-title":"J Bone Joint Surg Am","first-page":"1661","article-title":"Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery","volume":"99","author":"Yilgor C","year":"2017","unstructured":"Yilgor C, Sogunmez N, Boissiere L, Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99(19):1661\u20131672."},{"issue":"1","key":"b5","series-title":"Spine Deform","first-page":"121","article-title":"Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications","volume":"10","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Elysee J, Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. Spine Deform. 2022;10(1):121\u2013131."},{"issue":"5","key":"b6","series-title":"JBJS Rev","first-page":"e2","article-title":"Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review","volume":"6","author":"Iyer S","year":"2018","unstructured":"Iyer S, Sheha E, Fu MC, Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review. JBJS Rev. 2018;6(5):e2."},{"issue":"11","key":"b7","series-title":"Spine J","first-page":"994","article-title":"The use of the T1 sagittal angle in predicting overall sagittal balance of the spine","volume":"10","author":"Knott PT","year":"2010","unstructured":"Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J. 2010;10(11):994\u2013998."},{"issue":"3","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"185","article-title":"Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI","volume":"41","author":"Weng C","year":"2016","unstructured":"Weng C, Wang J, Tuchman A, Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976). 2016;41(3):185\u2013190."},{"issue":"1","key":"b9","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":"2019","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. 2019;30(1):31\u201337."},{"issue":"6","key":"b10","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."},{"key":"b11","series-title":"Adv Orthop","first-page":"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, Schwab F, Ames C, Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment. Adv Orthop. 2011;2011:415946."},{"issue":"3","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"E180","article-title":"Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis","volume":"37","author":"Lafage V","year":"2012","unstructured":"Lafage V, Ames C, Schwab F, Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine (Phila Pa 1976). 2012;37(3):E180\u2013E187."},{"issue":"19","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"1487","article-title":"The influence of age and sex on cervical spinal alignment among volunteers aged over 50","volume":"40","author":"Oe S","year":"2015","unstructured":"Oe S, Togawa D, Nakai K, The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine (Phila Pa 1976). 2015;40(19):1487\u20131494."},{"issue":"19","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"E1168","article-title":"Preoperative T1 slope more than 40 degrees as a risk factor of correction loss in patients with adult spinal deformity","volume":"41","author":"Oe S","year":"2016","unstructured":"Oe S, Yamato Y, Togawa D, Preoperative T1 slope more than 40 degrees as a risk factor of correction loss in patients with adult spinal deformity. Spine (Phila Pa 1976). 2016;41(19):E1168\u2013E1176."},{"issue":"11","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"829","article-title":"Results of the 2014 SRS Survey on PJK\/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development","volume":"40","author":"Scheer JK","year":"2015","unstructured":"Scheer JK, Fakurnejad S, Lau D, Results of the 2014 SRS Survey on PJK\/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development. Spine (Phila Pa 1976). 2015;40(11):829\u2013840."},{"issue":"6","key":"b16","series-title":"J Clin Med","first-page":"1586","article-title":"Conditions for achieving postoperative pelvic incidence-lumbar lordosis < 10 degrees in circumferential minimally invasive surgery for adult spinal deformity","volume":"11","author":"Ishihara M","year":"2022","unstructured":"Ishihara M, Taniguchi S, Adachi T, Conditions for achieving postoperative pelvic incidence-lumbar lordosis < 10 degrees in circumferential minimally invasive surgery for adult spinal deformity. J Clin Med. 2022;11(6):1586."},{"issue":"17","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"E1001","article-title":"Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity","volume":"39","author":"Smith JS","year":"2014","unstructured":"Smith JS, Lafage V, Schwab FJ, Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976). 2014;39(17):E1001\u2013E1009."},{"issue":"4","key":"b18","series-title":"Neurosurgery","first-page":"675","article-title":"Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity","volume":"83","author":"Passias PG","year":"2018","unstructured":"Passias PG, Horn SR, Jalai CM, Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity. Neurosurgery. 2018;83(4):675\u2013682."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"830","article-title":"Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformity: a 3-year radiographic analysis","volume":"34","author":"Passias PG","year":"2021","unstructured":"Passias PG, Alas H, Naessig S, Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformity: a 3-year radiographic analysis. J Neurosurg Spine. 2021;34(6):830\u2013838."},{"issue":"6","key":"b20","series-title":"J Neurosurg Spine","first-page":"742","article-title":"The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity","volume":"39","author":"Passfall L","year":"2023","unstructured":"Passfall L, Imbo B, Lafage V, The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity. J Neurosurg Spine. 2023;39(6):742\u2013750."},{"issue":"8","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"579","article-title":"Comparison of postoperative outcomes according to compensatory changes of the thoracic spine among patients with a T1 slope more than 40\u00b0","volume":"44","author":"Oe S","year":"2019","unstructured":"Oe S, Togawa D, Yamato Y, Comparison of postoperative outcomes according to compensatory changes of the thoracic spine among patients with a T1 slope more than 40\u00b0. 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