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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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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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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

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Michael Akbar, Haidara Almansour, Renaud Lafage, Bassel G. Diebo, Bernd Wiedenhöfer, Frank Schwab, Virginie Lafage and Wojciech Pepke

maintenance or restoration of normal sagittal alignment by using the Cotrel-Dubousset technique. 7 With this surgical method combined with Ponte osteotomy, 27 it is possible to correct hypokyphosis of the thoracic spine while preserving a normal LL in a notable percentage of patients with AIS. 2 , 8 , 17 Recent clinical and radiological investigations of surgically treated patients showed a correlation between the loss of normal TK and the development of CK, which was associated with frequent axial neck pain. 15 , 30 It has already been shown that sagittal plane

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Poong-Gi Ahn, Keung Nyun Kim, Sung Whan Moon and Keun Su Kim

adjacent segments to whole-neck motion was expressed as each segmental ROM/C2–7 ROM × 100. Radiographic Measurements of Cervical Sagittal Alignments The effects of ProDisc-C or cage insertion on cervical sagittal alignment were also evaluated. On cervical lateral radiographs in the neutral position, a sagittal Cobb angle with lordosis or kyphosis was expressed as a negative or positive value, respectively. The C2–7 Cobb angle was measured for a sagittal alignment of the whole cervical spine. The Cobb angle at the C5–6 FSU was measured for a sagittal alignment of

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Go Yoshida, Mituhiro Kamiya, Hisatake Yoshihara, Tokumi Kanemura, Fumihiko Kato, Yasutugu Yukawa, Keigo Ito, Yukihiro Matsuyama and Yoshihito Sakai

fixation, 11 , 12 , 16 which currently is widely used. However, few reports elucidate cervical alignment after atlantoaxial fixation achieved with the aforementioned surgical procedure. Moreover, the effect of atlantoaxial fixation on adjacent segments, including Oc–C1 and C2–3, remains unknown. In this investigation, we studied the effect of the C-1 lateral mass and C-2 pedicle screw fixation on subaxial sagittal alignment as well as adjacent-segment motion and degeneration in relation to the angle of atlantoaxial fixation, and compared these factors with those of