Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the ‘5W1H’ framework; “WHO” are related?, “WHY” important?, “WHAT” to evaluate and “WHAT” is normal?, “HOW” to evaluate?, “WHEN” to apply sagittal balance?, and “WHERE” to go in the future?
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Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty? Sibo Lin, Taotao Lin, Zhengru Wu, Gang Chen, Zhitao Shangguan, Zhenyu Wang, Wenge Liu The Spine Journal.2022; 22(12): 1953. CrossRef
Validity and reliability of a novel iPhone method to rapidly measure cervical sagittal parameters Jie Zhang, Chunyang Zhang, Weiyang Zhong, Zenghui Zhao, Fei Han, Zhenghan Han, Hang Zhang, Tianji Huang, Xiaoji Luo Scientific Reports.2022;[Epub] CrossRef
Changes in T1 slope and cervical sagittal vertical axis correlate to improved neurological function recovery after cervical laminoplasty Dong-Fan Wang, Xiang-Yu Li, Chao Kong, Cheng-Xin Liu, Bin Shi, Shi-Bao Lu Frontiers in Surgery.2022;[Epub] CrossRef
Total disc replacement alters the biomechanics of cervical spine based on sagittal cervical alignment Muzammil Mumtaz, Justin Mendoza, Sudharshan Tripathi, Amey Kelkar, Norihiro Nishida, Ashish Sahai, Vijay K. Goel Journal of Craniovertebral Junction and Spine.2022; 13(3): 278. CrossRef
Comparison of 3-level anterior cervical discectomy and fusion and open-door laminoplasty in cervical sagittal balance: A retrospective study Wenhao Wang, Yixue Huang, Zhikai Wu, Xiayu Hu, Pan Xiang, Hao Liu, Huilin Yang Frontiers in Surgery.2022;[Epub] CrossRef
Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma Jungmyung Koo, SungHwan Hwang, Sang Hoon Yoon, Hyung Jin Shin, Byung-Kyu Cho Korean Journal of Neurotrauma.2022; 18(2): 254. CrossRef
Predictable factors for aggravation of cervical alignment after posterior cervical foraminotomy Hyung Rae Lee, Dong-Ho Lee, Sang Yun Seok, Woon Sang Lee, Minsoo Kim, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee Journal of Neurosurgery: Spine.2022; : 1. CrossRef
Crossing the Cervicothoracic Junction Justin W. Vickery, Emil E. Varas, Amir M. Abtahi Clinical Spine Surgery.2022; 35(10): 451. CrossRef
Sagittal balance of the cervical spine in children older than 4 years: what is the norm? D. A. Glukhov, V. I. Zorin, Ya. A. Maltseva, A. Yu. Mushkin Hirurgiâ pozvonočnika (Spine Surgery).2022; 19(4): 19. CrossRef
Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim Neurospine.2022; 19(4): 912. CrossRef
Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature Hyung Cheol Kim, Sung Han Oh, Jae Keun Oh, Yoon Ha Neurospine.2022; 19(4): 868. CrossRef
Commentary on “Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery” Sang Hun Lee Neurospine.2022; 19(4): 921. CrossRef
Kinematics after cervical laminoplasty: risk factors for cervical kyphotic deformity after laminoplasty Bum-Joon Kim, Sung-Min Cho, Junseok W Hur, Jaehyung Cha, Se-Hoon Kim The Spine Journal.2021; 21(11): 1822. CrossRef
Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable? Seung-Jae Hyun, Lawrence G. Lenke, Yongjung Kim, Keith H. Bridwell, Meghan Cerpa, Kathy M. Blanke Journal of Korean Neurosurgical Society.2021; 64(5): 776. CrossRef
The state of the sagittal balance of the injured cervical spine depending on the nature of the damage to the subaxial level O.S. Nekhlopochyn, V.V. Verbov TRAUMA.2021; 22(3): 48. CrossRef
Cervical Sagittal Imbalance after Cervical Laminoplasty in Elderly Patients Hyun Woong Mun, Chang Duk Yuk, Tae Hwan Kim, Moon Soo Park, Seok Woo Kim, Ji Hee Kim, Jun Hyong Ahn, In Bok Chang, Joon Ho Song, Jae Keun Oh, Andrea Lovato BioMed Research International.2020;[Epub] CrossRef
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