{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:56Z","timestamp":1776096416843,"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":[[2026,1,30]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Adult spinal deformity (ASD) surgery is complex and may lead to postoperative cervical deformity (CD) and\/or proximal junctional kyphosis. The Roussouly classification describes four types of baseline thoracolumbar (TL) morphology, which differentially influence surgical outcomes. However, their role in predicting CD remains underexplored. This study aimed to stratify TL-ASD patients by Roussouly types and examine postoperative CD development patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors included operative ASD patients with no prior fusion and complete radiographic data at baseline, 6 weeks, 1 year, and 2 years. Patients were categorized into Roussouly types 1\u20134 using baseline pelvic incidence and lumbar lordosis apex. CD was assessed using a point system: cervical sagittal vertical axis (cSVA) of 40\u201380 mm = 1 point, T1 slope minus cervical lordosis (TSCL) of 15\u00b0\u201320\u00b0 = 1 point, cSVA &gt; 80 mm = 2 points, and TSCL &gt; 20\u00b0 = 2 points. CD was defined as a score \u2265 2. Statistical comparisons and multivariate logistic regression were used to assess CD risk across Roussouly types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 546 patients (77% female, mean age 60.9 \u00b1 14.3 years, mean BMI 27.3 \u00b1 5.7 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , mean Charlson Comorbidity Index score 1.7 \u00b1 1.7) were included. The mean number of fused posterior levels was 10.6 \u00b1 4.5, with a mean estimated blood loss of 1548 \u00b1 1450 mL, mean operative time of 438 \u00b1 180 minutes, and mean length of stay of 7.7 \u00b1 4.2 days. At baseline, 239 (43.8%) patients met CD criteria. The Roussouly distribution was as follows: type 1 (8.4%), type 2 (12.6%), type 3 (47.3%), and type 4 (31.7%). Among 307 patients without baseline CD, 174 (31.9%) developed CD within 2 years: 99 (32.2%) at 6 weeks, 44 (14.3%) at 1 year, and 31 (10.1%) at 2 years. Type 2 patients had higher odds of developing CD at 2 years compared to type 3 patients (OR 2.15, p = 0.019). Type 4 patients had lower odds of developing CD (OR 0.22, p = 0.12).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Roussouly type influences the timing and likelihood of CD following ASD correction. Type 1 patients tended to develop CD earlier, while type 2 patients showed delayed onset. Type 4 morphology may be protective against CD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.spine25745","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T16:10:10Z","timestamp":1770307810000},"page":"575-580","source":"Crossref","is-referenced-by-count":0,"title":["Does baseline thoracolumbar shape influence patterns of cervical decompensation following surgical adult spinal deformity correction?"],"prefix":"10.3171","volume":"44","author":[{"given":"Max R.","family":"Fisher","sequence":"first","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa M.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassel","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khoi D.","family":"Than","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"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"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Departments of Orthopaedic and Neurological Surgery, Duke University School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Int J Spine Surg","first-page":"725","article-title":"Development of new-onset cervical deformity in nonoperative adult spinal deformity patients with 2-year follow-up","volume":"12","author":"Passias PG","year":"2018","unstructured":"Passias PG, Jalai CM, Worley N,  Development of new-onset cervical deformity in nonoperative adult spinal deformity patients with 2-year follow-up. Int J Spine Surg. 2018;12(6):725\u2013734. doi:10.14444\/5091"},{"issue":"5","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"283","article-title":"Postoperative cervical deformity in 215 thoracolumbar patients with adult spinal deformity: prevalence, risk factors, and impact on patient-reported outcome and satisfaction at 2-year follow-up","volume":"40","author":"Passias PG","year":"2015","unstructured":"Passias PG, Soroceanu A, Smith J,  Postoperative cervical deformity in 215 thoracolumbar patients with adult spinal deformity: prevalence, risk factors, and impact on patient-reported outcome and satisfaction at 2-year follow-up. 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Neurosurgery. 2016;79(3):378\u2013388. doi:10.1227\/NEU.0000000000001129"},{"issue":"6","key":"b5","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. 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Complications following surgery for adult Scheuermann\u2019s kyphosis: a 2-year follow-up in 22 patients. Turk Neurosurg. 2022;32(3):471\u2013480. doi:10.5137\/1019-5149.JTN.35974-21.2"},{"issue":"5","key":"b9","series-title":"Spine Deform","first-page":"1027","article-title":"Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications","volume":"8","author":"Bari TJ","year":"2020","unstructured":"Bari TJ, Hansen LV, Gehrchen M. Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. 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The analysis of preoperative Roussouly classification on pain scores and radiological data in lateral lumbar interbody fusion for patients with lumbar degenerative disease. World Neurosurg. 2023;175:e380\u2013e390. doi:10.1016\/j.wneu.2023.03.102"},{"issue":"2","key":"b22","series-title":"J Neurosurg Spine","first-page":"153","article-title":"How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up","volume":"23","author":"Protopsaltis TS","year":"2015","unstructured":"Protopsaltis TS, Scheer JK, Terran JS,  How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. 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Complications following surgery for adult Scheuermann\u2019s kyphosis: a 2-year follow-up in 22 patients. Turk Neurosurg. 2022;32(3):471\u2013480. doi:10.5137\/1019-5149.JTN.35974-21.2"},{"issue":"5","key":"b9","series-title":"Spine Deform","first-page":"1027","article-title":"Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications","volume":"8","author":"Bari TJ","year":"2020","unstructured":"Bari TJ, Hansen LV, Gehrchen M. Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. 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Spine (Phila Pa 1976). 2019;44(11):777\u2013784. doi:10.1097\/BRS.0000000000002955"},{"issue":"4","key":"b13","series-title":"Eur Spine J","first-page":"1111","article-title":"Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA","volume":"26","author":"Protopsaltis T","year":"2017","unstructured":"Protopsaltis T, Bronsard N, Soroceanu A,  Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA. 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