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"Sagittal alignment"

Original Article

Clinical Study – Cervical Spine

Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Yong Eun Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Joongkyum Shin, Yoon Ha
Neurospine 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554

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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554
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Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion
Neurospine. 2025;22(4):937-948.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551108.554
Close
Objective
To evaluate the clinical significance of a negative K-line in the neck flexion position (FK-line [-]), which indicates that cervical ossification of the posterior longitudinal ligament (OPLL) crosses the K-line during flexion, and to compare surgical outcomes between laminoplasty (LP) and laminectomy with fusion (LF) for multilevel FK-line (-) cervical OPLL.
Methods
A total of 349 patients with multiple cervical OPLL who underwent posterior decompression surgery (LP or LF) with a minimum of 2 years of follow-up were stratified by FK-line status. Clinical and radiological parameters were compared between the FK-line (+) and FK-line (-) groups. Subgroup analysis of FK-line (-) patients evaluated the efficacy of LP versus LF. Multivariate regression identified predictors of neurological recovery.
Results
Patients with FK-line (-) OPLL exhibited a smaller FK-line distance, more kyphotic alignment, greater cervical flexion, and lower recovery ratios compared to those with FK-line (+). In the FK-line (-) subgroup, LF achieved a significantly greater increase in FK-line distance, better correction of the flexion angle, and more neurological recovery than LP. Multivariate analyses identified postoperative FK-line distance, C2–7 flexion angle, and preoperative dynamic extension reserve as independent predictors of neurological outcomes.
Conclusion
FK-line status reflects the sagittal cord position and predicts surgical outcomes in cervical OPLL. In FK-line (-) patients, LF provides better neurological recovery and more effective posterior cord shift and kyphotic alignment correction than LP. Incorporating FK-line assessment to guide surgical planning could improve individualized treatment outcomes for multilevel OPLL.

Citations

Citations to this article as recorded by  Crossref logo
  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    John H. Chi
    Neurospine.2025; 22(4): 951.     CrossRef
  • A Commentary on “Flexion K-Line Status Predicts Surgical Strategy in Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Comparison of Laminoplasty and Laminectomy With Fusion”
    Yutaro Kanda
    Neurospine.2025; 22(4): 949.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2025 Issue
    Inbo Han
    Neurospine.2025; 22(4): 877.     CrossRef
  • 1,967 View
  • 88 Download
  • 3 Web of Science
  • 3 Crossref

Review Article

Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
Neurospine 2023;20(4):1246-1255.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346744.372

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Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
Neurospine. 2023;20(4):1246-1255.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346744.372
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Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
Neurospine. 2023;20(4):1246-1255.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346744.372
Close
Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curvature and cervical spine alignment. It can lead to a multitude of symptoms, including chronic pain, neurological deficits, and functional impairments, severely impacting an individual’s health-related quality of life (HRQoL). Surgical intervention is often necessary to address the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhancing readers’ understanding of the complexities involved. We begin by discussing the importance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision-making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers’ knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.

Citations

Citations to this article as recorded by  Crossref logo
  • A systematic review and meta-analysis of sagittal cervical spine parameters: Normative values, correlation with quality of life, and biomechanical modeling
    Vinicius Ricieri Ferraz, Carlos R. Goulart, Tobias Alecio Mattei
    North American Spine Society Journal (NASSJ).2026; 25: 100819.     CrossRef
  • Lordosis Distribution Index in an Asymptomatic Elderly Population : The Role of Lower and Upper Lumbar Lordosis According to Individual Pelvic Incidence and Roussouly Type
    Seung-Jae Hyun, Sanghyun Han, Youngbae B. Kim
    Journal of Korean Neurosurgical Society.2026; 69(1): 92.     CrossRef
  • Impact of T1 Slope as a Predictor of Loss of Cervical Lordosis and Health-Related Quality of Life after Laminoplasty in Patients with Ossification of the Posterior Longitudinal Ligament : A Retrospective Cohort Study
    Ji-Ho Jung, Jong-Hoon Jeong, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
    Journal of Korean Neurosurgical Society.2026; 69(1): 124.     CrossRef
  • C2 Slope as an Independent Predictor of Cervical Lordosis Loss Following Laminoplasty
    Bin Zheng, Panfeng Yu, Zhenqi Zhu, Yan Liang, Haiying Liu
    Orthopaedic Surgery.2026; 18(3): 569.     CrossRef
  • Does Higher T1 Slope Predict Poor Outcomes Following Posterior Cervical Fusion for Degenerative Pathology?
    Harsh Jain, Sameer Sundrani, Iyan Younus, Nick De Oliveira, Omar Zakieh, Maryam Jawid, Naadir Jamal, Hani Chanbour, Tyler Zeoli, Ranbir Ahluwalia, Mitchell Bowers, Raymond J. Gardocki, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman
    World Neurosurgery.2026; 209: 124920.     CrossRef
  • Sagittal balance of the cervical spine in adults: a non-systematic literature review
    R. S. Chernyshyov, V. B. Lebedev, B. R. Kinzyagulov, A. A. Zuev
    Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika).2026; 23(1): 92.     CrossRef
  • Investigation of spinopelvic sagittal alignment and its correlations in asymptomatic pediatric populations
    Hao Qi, ZengHui Zhao, Feiyu Zu, Chenchen Wang, Chenxi Wang, Zuzhuo Zhang, Jianhua Ren, Rui Xue, Zhaoxuan Wang, Zhiyong Hou, Wei Chen, Di Zhang
    Scientific Reports.2025;[Epub]     CrossRef
  • Cervical Sagittal Alignment Revisited on the Path to Personalized Spine Surgery: A Big Picture Perspective Through Bibliometric Analysis and Visualization
    Luke L. Jouppi, Clifford Pierre, Anna Gorbacheva, Julius Gerstmeyer, Colin Gold, Cameron Hogsett, Nicholas Minissale, Mark Kraemer, Stephen Lockey, Amir Abdul-Jabbar, Rod J. Oskouian, Jens R. Chapman
    World Neurosurgery.2025; 202: 124387.     CrossRef
  • 6,041 View
  • 287 Download
  • 7 Web of Science
  • 8 Crossref

Original Articles

Outcomes of Surgical Treatment for Patients With Mild Scoliosis and Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-up
Justin K. Scheer, Justin S. Smith, Peter G. Passias, Han Jo Kim, Shay Bess, Douglas C. Burton, Eric O. Klineberg, Virginie Lafage, Munish Gupta, Christopher P. Ames, The International Spine Study Group
Neurospine 2023;20(3):837-848.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346454.227

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Outcomes of Surgical Treatment for Patients With Mild Scoliosis and Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-up
Neurospine. 2023;20(3):837-848.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346454.227
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Outcomes of Surgical Treatment for Patients With Mild Scoliosis and Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-up
Neurospine. 2023;20(3):837-848.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346454.227
Close
Objective
The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction.
Methods
Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI–LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°–30°) were compared to those with larger curves (Scoli).
Results
One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p < 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p < 0.001). All 2-year HRQoL measures were significantly improved compared to (p < 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p > 0.05). From the mild Scoli group, 36%–74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation.
Conclusion
Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate.

Citations

Citations to this article as recorded by  Crossref logo
  • Subject‐Specific Musculoskeletal Modeling: The Future of Predicting and Preventing Proximal Junctional Failure in Adult Spinal Deformity
    Nima Ashjaee, Alexa Semonche, Anthony L. Mikula, Laszlo Kiss, Dennis E. Anderson, Dominika Ignasiak, Stephen H. M. Brown, John Street, Sidney Fels, Samuel R. Ward, Christopher Ames, Thomas R. Oxland
    JOR SPINE.2025;[Epub]     CrossRef
  • 5,375 View
  • 158 Download
  • 3 Web of Science
  • 1 Crossref
The Posterior Cranial Vertical Line: A Novel Radiographic Marker for Classifying Global Sagittal Alignment
Paul J. Park, Fthimnir M. Hassan, Xavier E. Ferrer, Cole Morrissette, Nathan J. Lee, Meghan Cerpa, Zeeshan M. Sardar, Michael P. Kelly, Stephane Bourret, Kazuhiro Hasegawa, Hee-Kit Wong, Gabriel Liu, Hwee Weng Dennis Hey, Hend Riahi, Jean-Charles Le Huec, Lawrence G. Lenke
Neurospine 2023;20(3):790-797.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346408.204

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The Posterior Cranial Vertical Line: A Novel Radiographic Marker for Classifying Global Sagittal Alignment
Neurospine. 2023;20(3):790-797.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346408.204
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The Posterior Cranial Vertical Line: A Novel Radiographic Marker for Classifying Global Sagittal Alignment
Neurospine. 2023;20(3):790-797.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346408.204
Close
Objective
To define a novel radiographic measurement, the posterior cranial vertical line (PCVL), in an asymptomatic adult population to better understand global sagittal alignment.
Methods
We performed a multicenter retrospective review of prospectively collected radiographic data on asymptomatic volunteers aged 20–79. The PCVL is a vertical plumb line drawn from the posterior-most aspect of the occiput. The horizontal distances of the PCVL to the thoracic apex (TA), posterior sagittal vertical line (PSVL, posterosuperior endplate of S1), femoral head center, and tibial plafond were measured. Classification was either grade 1 (PCVL posterior to TA and PSVL), grade 2 (PCVL anterior to TA and posterior to PSVL), or grade 3 (PCVL anterior to TA and PSVL).
Results
Three hundred thirty-four asymptomatic patients were evaluated with a mean age of 41 years. Eighty-three percent of subjects were PCVL grade 1, 15% were grade 2, and 3% were grade 3. Increasing PCVL grade was associated with increased age (p < 0.001), C7–S1 sagittal vertical axis (SVA) (p < 0.001), C2–7 SVA (p < 0.001). Additionally, it was associated with decreased SS (p = 0.045), increased PT (p < 0.001), and increased knee flexion (p < 0.001).
Conclusion
The PCVL is a radiographic marker of global sagittal alignment that is simple to implement and interpret. Increasing PCVL grade was significantly associated with expected changes and compensatory mechanisms in the aging population. Most importantly, it incorporates cervical alignment parameters such as C2–7 SVA. The PCVL defines global sagittal alignment in adult volunteers and naturally distributes into 3 grades, with only 3% being grade 3 where the PCVL lies anterior to the TA and PSVL.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical Application of the EOS Imaging System—The Broader Horizon
    Karen Brage, Bo Mussmann, Malene Roland Pedersen, Marcus Nissen, Oliver Brage, Svea Deppe Mørup, Mats Geijer, Palle Larsen, Janni Jensen
    Journal of the Oman Medical Association.2025; 2(1): 7.     CrossRef
  • 6,081 View
  • 193 Download
  • 4 Web of Science
  • 1 Crossref

CSRS Special Issue

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):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302

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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302
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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302
Close
Objective
C2 slope (C2S), a cervical parameter mathematically approximated as T1 slope minus cervical lordosis (T1S–CL), predicts functional improvement in cervical deformity patients. Nonetheless, C2S is a positional parameter based only on the horizontal axis. The current study aims to introduce novel odontoid parameters and establish their relationships with patient-reported health-related quality of life (HRQoL).
Methods
Lateral plain radiographs of 32 adults who underwent multilevel posterior cervical fusion were analyzed. The odontoid parameters included odontoid incidence (OI), C2S, odontoid tilt (OT), and gravity line-C2 distance (GL-C2), while the cervical parameters were the Cobb angle at C0–1, C1–2, C0–2, C2–7, C2–7 sagittal vertical axis (cSVA), T1 slope, and T1S–CL. The range of motion (ROM) of the occipito-atlantoaxial complex was measured in flexion and extension plain radiographs. Scores on the Neck Disability Index (NDI) and visual analogue scale (VAS) for axial neck (VASn) and arm pain were measured.
Results
Compared to asymptomatic subjects, patients had larger C2S, cSVA, and T1S–CL, and smaller OT. Preoperatively, OI was significantly correlated with the ROM of C1–2 (r = 0.37, p < 0.05) and C0–2 (r = 0.46, p < 0.01). OT and C2S had significant correlations with the C0–1, C1–2, and C0–2 angles, GL-C2, and T1S–CL. Postoperative NDI scores were significantly correlated with OI (r = -0.40, p < 0.05) and OT (ρ = -0.37, p < 0.05). VASn was significantly correlated with GL-C2 (r = -0.35, p < 0.05).
Conclusion
The odontoid parameters were significantly correlated with established cervical parameters and HRQoL measures. OI is a constant parameter representing the individual's compensatory reservoir at the upper cervical spine.

Citations

Citations to this article as recorded by  Crossref logo
  • Odontoid Parameters in Adolescent Idiopathic Scoliosis Patients
    Qiong-run Xiao, Long-ao Huang, Ke-lin Li, Yu-wang Du, Xiao Liang, Chong-yang Wang, Hua Jiang
    Clinical Spine Surgery.2026; 39(2): E74.     CrossRef
  • The effect of cervical spine flexion-extension motion on odontoid parameters
    Longao Huang, Dun Liu, Hongyuan Xu, Junfei Feng, Tao Kang, Shengwang Wei, Hua Jiang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion
    Yan Gong, Hao Liu, Yanchi Gan, Jiahui He, Zelin Zhou, Hang Zhuo, Yu Liu, De Liang, Hui Ren, Xiaobing Jiang, Zhaojun Cheng
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion (ACCF): retrospective study of 102 patients with minimum 2-year follow-up
    Haoxiang Wang, Tian Xia, Ruomu Qu, Hanbo Geng, Yu Sun, Fengshan Zhang, Shengfa Pan, Xin Chen, Yanbin Zhao, Feifei Zhou
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Impact of anterior controllable antedisplacement and fusion (ACAF) on cervical lordosis and sagittal alignment in OPLL: A comparative radiographic analysis
    Shunmin Wang, Dong Liu, Jincui Li, Jingchuan Sun, Tiefeng Li, Jiangang Shi
    Journal of Orthopaedics.2025; 70: 158.     CrossRef
  • Odontoid parameters in subjects with and without degenerative cervical spondylosis
    Tao Kang, Weiyou Chen, Longao Huang, Hongyuan Xu, Hua Jiang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Introducing the Modified Cobb Angle for Measuring Cervical Spine Curvature During Swallowing
    Catriona M. Steele, Makaya O' Grady, Sima Farpour, Melanie Peladeau‐Pigeon, Sophia Werden Abrams, Maureen Folsom, Emily K. Plowman, Ashwini M. Namasivayam‐MacDonald
    Laryngoscope Investigative Otolaryngology.2025;[Epub]     CrossRef
  • The Significance of Odontoid Incidence in Patients With Cervical Spondylotic Myelopathy
    Hongyu Qin, Weiyou Chen, Longao Huang, Xin Xiao, Qinghua Yang, Hua Jiang
    Global Spine Journal.2024; 14(8): 2374.     CrossRef
  • Variation of Odontoid Incidence According to Age in Asymptomatic Children
    Yuwang Du, Weiyou Chen, Hongyuan Xu, Xiao Liang, Chongyang Wang, Hongyu Qin, Hua Jiang
    World Neurosurgery.2024; 190: e496.     CrossRef
  • Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Proced
    Junho Mun, Seung-Jae Hyun, Jae-Koo Lee, Sungjae An, Ki-Jeong Kim
    Neurospine.2023; 20(3): 981.     CrossRef
  • Selection of Optimal Lower Instrumented Vertebra for Adolescent Idiopathic Scoliosis Surgery
    Seung-Ho Seo, Seung-Jae Hyun, Jae-Koo Lee, Yong Jae Cho, Dae Jean Jo, Jin Hoon Park, Ki-Jeong Kim
    Neurospine.2023; 20(3): 799.     CrossRef
  • Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
    Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
    Neurospine.2023; 20(4): 1246.     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
  • Significance of Atlantoaxial and Subaxial Spinal Instability in Cervical Spinal Spondylosis: Commentary on “Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery”
    Atul Goel
    Neurospine.2022; 19(4): 924.     CrossRef
  • 7,257 View
  • 214 Download
  • 14 Crossref

Regular Issue

Relationship Between Syrinx Resolution and Cervical Sagittal Realignment Following Decompression Surgery for Chiari I Malformation Related Syringomyelia Based on Configuration Phenotypes
Chunli Lu, Longbing Ma, Jian Guan, Zhenlei Liu, Kai Wang, Wanru Duan, Zan Chen, Hao Wu, Fengzeng Jian
Neurospine 2022;19(4):1057-1070.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244530.265

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Relationship Between Syrinx Resolution and Cervical Sagittal Realignment Following Decompression Surgery for Chiari I Malformation Related Syringomyelia Based on Configuration Phenotypes
Neurospine. 2022;19(4):1057-1070.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244530.265
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Relationship Between Syrinx Resolution and Cervical Sagittal Realignment Following Decompression Surgery for Chiari I Malformation Related Syringomyelia Based on Configuration Phenotypes
Neurospine. 2022;19(4):1057-1070.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244530.265
Close
Objective
Combined with different configuration types of syringomyelia, to analyze the correlation between syrinx resolution and changes in cervical sagittal alignment following Foramen magnum and Magendie dredging (FMMD) for syringomyelia associated with Chiari I malformation (CM-I), and to further explore the respective relationship with clinical outcome.
Methods
A consecutive series of 127 patients with CM-I and syringomyelia who underwent FMMD in our center met the inclusion criteria of this study. Their clinical records and radiologic data were retrospectively reviewed. The Japanese Orthopedic Association (JOA) scoring system and the Chicago Chiari Outcome Scale (CCOS) were used to evaluate the surgical efficacy. The phenotypes of syringomyelia and the clinical characteristics of the patients were analyzed according to grouping by cervical curvature at baseline.
Results
The preoperative straight or kyphotic cervical alignment is more common in the moniliform syrinx. After surgery, the syrinx resolution and cervical sagittal realignment in the moniliform group are more obvious, and the corresponding prognosis is relatively better. Spearman correlation analysis showed that the ΔS/C ratio (the change ratio of syrinx/cord) was positively correlated with the CCOS (p = 0.001, r = 0.897) and ΔC2–7A (the change of lower cervical angle) (p = 0.002, r = 0.560). There was also a correlation between the ΔJOA score (the change rate of the JOA score) and ΔC2–7A (p = 0.012, r = 0.467).
Conclusion
After decompression surgery, syrinx resolution may coexist with the changes in the subaxial lordosis angle, especially for syrinx in moniliform type, and the relationship between syrinx resolution and cervical sagittal realignment might be valuable for evaluating the surgical outcome.

Citations

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  • Efficacy of neurosurgical intervention in syrinx resolution in patients presenting with Chiari malformation type I and syringomyelia: a systematic review and radiological meta-analysis
    Adharsh Suraj Prasad, Aqif Farhan bin Azmil Farid, Isaac Tang Jing Wen, Thomas Zhang, Chandrasekaran Kaliaperumal
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Correlation Among Syrinx Resolution, Cervical Sagittal Realignment, and Surgical Outcome After Posterior Reduction for Basilar Invagination, Atlantoaxial Dislocation, and Syringomyelia
    Chunli Lu, Wanru Duan, Can Zhang, Yueqi Du, Xinyu Wang, Longbing Ma, Kai Wang, Hao Wu, Zan Chen, Fengzeng Jian
    Operative Neurosurgery.2023; 25(2): 125.     CrossRef
  • Individualized Functional Decompression Options for Adult Chiari Malformation With Syringomyelia and A Novel Scale for Syringomyelia Resolution: A Single-Center Experience
    Shiyuan Han, Bo Hou, Zhimin Li, Feng Feng, Yongning Li, Jun Gao
    Neurospine.2023; 20(4): 1501.     CrossRef
  • 10,582 View
  • 170 Download
  • 4 Web of Science
  • 3 Crossref
Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
Neurospine 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110

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Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Neurospine. 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110
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Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Neurospine. 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110
Close
Objective
By using angulation of the axis itself, this study aims to define and analyze odontoid incidence (OI) and odontoid tilt (OT) as novel cervical alignment parameters and investigate their correlations with cervical alignment.
Methods
Novel and existing parameters were measured with whole-spine lateral plain radiographs and EOS images of 42 adults without cervical symptoms. The correlations of OI, OT, C2 slope (C2S), and T1 slope (T1S) were calculated.
Results
The OI, OT, and C2S showed significant correlations with C2–7 angle (r = 0.43, r = -0.42, r = 0.62, respectively) and C0–2 angle (r = -0.33, r = 0.48, r = -0.61, respectively). OI, OT, T1S were independent predictors of the C2–7 angle in univariate regression analysis (adjusted-R2 = 0.17, R2 = 0.15, R2 = 0.28, respectively). OI, OT, and T1S were independent predictors in the multivariable regression analysis with estimated standardized coefficients of 0.36, -0.67, -0.69, respectively (adjusted- R2 = 0.80, p < 0.001). Regarding the C0–2 angle, OI and OT were independent predictors in the univariate regression analysis (adjusted-R2 = 0.08, R2 = 0.21, respectively).
Conclusion
OI, OT, and C2S had significant correlations with cervical alignment. As the pelvic incidence, the OI is the only anatomical and constant parameter that could be used as a reference point related to the cervical spine from the rostral end. The study results may serve as baseline data for further studies on the alignment and balance of the cervical spine.

Citations

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Technical Note

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Dong-Ho Lee, Sehan Park, Woon Sang Lee, Chan Woong Byun, Sang Yun Seok, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee, Hyung Rae Lee
Neurospine 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241

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Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Neurospine. 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241
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Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Neurospine. 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241
Close
Cervical spondylotic myelopathy is surgically demanding when associated with rigid kyphosis. Posterior surgery cannot restore cervical lordosis, and adequate decompression is not possible with rigid kyphosis. Vertebral body sliding osteotomy (VBSO) is a safe and novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. It is safe in terms of dural tear, pseudarthrosis, and graft dislodgement, which are demonstrated at high rates in anterior cervical corpectomy and fusion. In addition, VBSO is a powerful method for restoring cervical lordosis through multilevel anterior cervical discectomy and fusion above and below the osteotomy level. It may be a feasible treatment option for patients with cervical spondylotic myelopathy and kyphotic deformity. This is a technical note and literature review that describes the procedures involved in VBSO.

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Review Article

Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review
Chang-Wook Kim, Seung-Jae Hyun, Ki-Jeong Kim
Neurospine 2020;17(3):497-504.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040476.238

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Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review
Neurospine. 2020;17(3):497-504.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040476.238
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Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review
Neurospine. 2020;17(3):497-504.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040476.238
Close
When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. These compensations occur through mobile spine segments as well as pelvic tilt and lower extremities. The purpose of this review was to understand the surgical impact on global sagittal alignment and health-related quality of life (HRQoL) following cervical kyphosis correction surgery. The cervical kyphosis correction surgery induces reciprocal changes in craniocervical and thoracolumbar alignment. Successful cervical deformity correction needs to focus not only on restoring proper cervical lordosis, but also on achieving global balance of the cervical spine with other parts of the spine. The goal of the surgery is to achieve occiputtrunk (OT) concordance (the center of gravity-C7 sagittal vertical axis < 30 mm) and cervical sagittal balance. Once OT-concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize global spinal alignment. Reciprocal changes after surgery exhibit different patterns depending on whether patients have compensation ability in their thoracolumbar spine or not. C2–7 sagittal vertical axis and sagittal morphotype of the cervical kyphosis are correlated with HRQoL. Changes in cervical lordosis minus T1 slope correlate to HRQoL improvements.

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Clinical Article

Cervical Sagittal Alignment Parameters of Patients Admitted to Neurosurgery and Emergency Clinics in a State Hospital at Eastern Part of Turkey
Sümeyye Çoruh Kaplan, Murat Şakir Ekşi
Korean J Spine 2015;12(2):75-78.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.75

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Cervical Sagittal Alignment Parameters of Patients Admitted to Neurosurgery and Emergency Clinics in a State Hospital at Eastern Part of Turkey
Korean J Spine. 2015;12(2):75-78.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.75
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Cervical Sagittal Alignment Parameters of Patients Admitted to Neurosurgery and Emergency Clinics in a State Hospital at Eastern Part of Turkey
Korean J Spine. 2015;12(2):75-78.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.75
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Objective

Cervical spine encompasses a bridge role between the head and the lower parts of the spine and therefore has unique properties. Our aim in this study was to evaluate the cervical sagittal alignment parameters in pediatric and adult non-surgical patients and to find any differences in respect of age, sex and admission type.

Methods

All patients who were admitted to emergency and neurosurgery clinics of Diyarbakir Bismil State Hospital due to cervical spine problems (trauma, radiculopathy, paraspinal pain) in 2014 were enrolled retrospectively into the study. Cervical anterior-posterior and lateral X-rays were obtained. Our exclusion criteria were cervical coronal deformity, multitrauma, Glasgow Coma Scale <15, traumatic disruption of the cervical spine, history of malignancy, spinal infection, metabolic or rheumatologic diseases.

Results

There were 44 female and 55 male patients (n=99) in the study. Thirty-five (35.35%) of the patients were younger than 18 years of age. Mean cervical spinal alignment parameters were as follows: -42.81±11.23° (OC2), -17.15±11.48° (C2-C7), -29.82±7.60° (T1 slope), -3.62±3.05° (C3), -3.14±3.05 (C4), -3.80±2.74° (C5), -3.12±2.36° (C6), -3.43±2.53° (C7). Positive correlations were observed between age-C2C7 angle, C2C7 angle-T1 slope, C3 angle-C4 angle, C4 angle-OC2 angle, C4 angle-T1 slope, C4 angle-C5 angle. The one only negative correlation was between OC2 angle-C2C7 angle.

Conclusion

In this regional study, it has been observed that global cervical lordosis increases as age increases. C4 vertebra is in the middle of this evaluation as it has many correlations with other cervical segments, which should be kept in mind when making surgical plans for this delicate spine region.

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NS : Neurospine
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