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Ryan Snowden, Justin Miller, Tome Saidon, Joseph D. Smucker, K. Daniel Riew and Rick Sasso

have shown that arthroplasty compares favorably to ACDF and shows superiority in a variety of outcome measures. 1 , 2 , 6 , 9 , 29 , 34 However, long-term improvements in patients with CASP and RASP have been varied. 8 , 12 , 19 , 23 , 25 , 31 , 32 The development of RASP is likely a combination of both natural history and changes in biomechanical factors. More recently, a greater emphasis has been placed on the maintenance of sagittal alignment following TDA and ACDF. Loss of this balance has been identified as a risk factor for both RASP and CASP, increasing neck

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Ming-Qiao Fang, Chong Wang, Guang-Heng Xiang, Chao Lou, Nai-Feng Tian and Hua-Zi Xu

coronal plane. However, the other 3D parameters are of primary importance, because it is mandatory to stabilize the coronal plane without creating adverse effects on sagittal alignment and transverse plane parameters. Many brace-related concepts have resulted in good correction but have had a deleterious effect on the sagittal profile, which may be related to the production of lumbar and thoracic flat back. The Chêneau system was designed with the principles of 3D correction in mind. The anterior pad pushes the lumbar and thoracic regions backward to fight posterior

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Emmanuelle Ferrero, Barthelemy Liabaud, Jensen K. Henry, Christopher P. Ames, Khaled Kebaish, Gregory M. Mundis, Richard Hostin, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Robert A. Hart, Ibrahim Obeid, Bassel G. Diebo, Frank J. Schwab and Virginie Lafage

timing of revision surgery (up to 2 years postoperatively). Radiographic Measurement Radiographs were analyzed using validated software (Spineview, ENSAM Paris-Tech). 34 Sagittal spinopelvic radiographic parameters included cervical lordosis, T2–12 thoracic kyphosis (TK), LL, PI-LL mismatch, and pelvic parameters (PI, PT, and sacral slope). 46 Global sagittal alignment parameters included SVA and T-1 spinopelvic inclination (T1SPi) ( Fig. 1 ). The 3CO resection angle was defined as the change in the angle formed by the upper endplate of the vertebra below the 3CO and

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Jae Hwan Cho, Chang Ju Hwang, Young Hyun Choi, Dong-Ho Lee and Choon Sung Lee

surgery on cervical sagittal alignment (CSA) is not clearly defined. Cervical lordosis has been reported to decrease following corrective surgery in patients with Lenke type 1 AIS. 6 In addition, the cervical spine may tend to decompensate independent of the surgical technique. 14 However, there have been varied opinions on postoperative CSA. Reportedly, the effect of corrective surgery on CSA may be determined based on the preoperative thoracic sagittal profile, 18 that is, cervical lordosis improves postoperatively in patients with preoperative hypokyphosis

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Jee-Soo Jang, Sang-Ho Lee, Jun-Hong Min and Dae Hyeon Maeng

generate adequate lumbar lordosis. 13 , 15 All patients in the present study underwent a combined anterior and posterior surgical approach to restore lumbar lordosis without the use of posterior wedge osteotomy. There were four operation-related complications in this study as follows: incision abdominal hernia (in two patients), screw malposition (in one patient), and radiculopathy that required revision surgery (one patient). Conclusions Lower lumbar lordosis plays an important role in sagittal alignment and balance. Surgical restoration of lower lumbar lordosis

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Roland D. Donk, Michael G. Fehlings, Wim I. M. Verhagen, Hisse Arnts, Hans Groenewoud, André L. M. Verbeek and Ronald H. M. A. Bartels

spine correctly. A comparison between a quantitative assessment of the sagittal alignment of the cervical spine with the actual angle measured by the posterior tangent method has never been performed. A clear definition of the shape of the cervical spine is of interest for clinical use, but also for research purposes. In this study we compared the quantification of the angle between C-2 and C-7 by using Harrison's posterior tangent method, with a quantitative assessment of the curve performed using the modified Toyama method. Methods The study was approved by the

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Themistocles S. Protopsaltis, Justin K. Scheer, Jamie S. Terran, Justin S. Smith, D. Kojo Hamilton, Han Jo Kim, Greg M. Mundis Jr., Robert A. Hart, Ian M. McCarthy, Eric Klineberg, Virginie Lafage, Shay Bess, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames and International Spine Study Group

A dult spinal deformity has been studied extensively in the literature with a majority of publications focusing on thoracolumbar deformity and its effect on health-related quality of life (HRQOL) measures. 1 , 3 , 6 , 7 , 10 , 11 , 13 , 14 , 16 , 17 Among patients with thoracolumbar deformities, positive sagittal alignment has been associated with pain and disability. 2 , 7 , 11 , 13 , 16 Few studies have correlated validated health measures and positive cervical sagittal alignment. 16 , 17 Tang et al. 16 demonstrated that a C2–7 sagittal vertical axis

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Richard D. Ferch, Amjad Shad, Tom A. D. Cadoux-Hudson and Peter J. Teddy

T he sagittal alignment of the spine can be altered by diseases affecting the spine or following spinal surgery. The loss of normal cervical lordosis associated with the development of a kyphotic deformity can be progressive. This may lead to adjacent-segment disease and the development of neurological deficit. 36 Biomechanical interactions facilitate this development of progressive deformity, resulting in a bowstring effect on the cord that may compromise its function despite the presence of an adequate canal diameter. 2, 4, 19 Anterior decompression of

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Yong-Chan Kim, Ji Hao Cui, Ki-Tack Kim, Gyu-Taek Park, Keun-Ho Lee, Sung-Min Kim and Lawrence G. Lenke

M any studies on sagittal balance in humans in the standing position have been published, 1 , 6 , 10 , 11 , 36 and sagittal imbalance is known to be a major cause of pain and disability in spine deformity patients. 7 However, most of these studies have focused primarily on the thoracolumbar spine and pelvis. 1 , 2 , 6 , 8 , 9 , 31 , 32 , 35 Recently, the importance of integrating the head and cervical spine in the evaluation of sagittal alignment has begun to be recognized. 18 , 34 Simplistically, the goal of spinal deformity correction is to keep the head

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Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Hyun Chul Shin, Do Heum Yoon and Yoon Ha

concerns, a variety of laminoplasty techniques have been developed to decrease postoperative kyphotic deformity. However, some authors have reported kyphotic deformity even after laminoplasty. Patients who undergo laminoplasty tend to have a change in kyphotic alignment and increased axial neck pain, which can lead to poor surgical outcomes. To our knowledge, no previous study has evaluated whether cervical sagittal alignment after laminoplasty for OPLL is related to health-related quality of life (HRQOL). The object of this study was to assess several different