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Ryan C. Hofler, Muturi G. Muriuki, Robert M. Havey, Kenneth R. Blank, Joseph N. Frazzetta, Avinash G. Patwardhan, and G. Alexander Jones

foundation for much of the work that followed. While the relationship between T1 tilt and the cervical sagittal vertical axis (CSVA) has been described more recently in the clinical literature, 4–6 no biomechanical study exists, to date, to describe this dynamic interaction. Thus, we conducted a study to determine whether a change in T1 tilt results in a compensatory change in the CSVA in a cadaveric spine model. Methods Specimen Preparation The experiments were performed using 6 fresh-frozen human cadaveric cervical spine specimens (occiput–T1) ( Table 1 ). The muscle

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Nitin Agarwal, Federico Angriman, Ezequiel Goldschmidt, James Zhou, Adam S. Kanter, David O. Okonkwo, Peter G. Passias, Themistocles Protopsaltis, Virginie Lafage, Renaud Lafage, Frank Schwab, Shay Bess, Christopher Ames, Justin S. Smith, Christopher I. Shaffrey, Douglas Burton, D. Kojo Hamilton, and the International Spine Study Group

O verall sagittal balance of the vertebral column is an important predictor of health-related quality of life (HRQoL) both before and after spine deformity surgery. 9 Previous studies have shown that sagittal malalignment in patients with spinal deformity is directly correlated with poor quality of life measures such as low-back pain and disability. 6 , 7 , 19 Postoperative improvement of the sagittal vertical axis (SVA) has been shown repeatedly to correlate with improved outcomes following deformity surgery. 1 , 2 , 10 Moreover, restoration of a normal SVA

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Justin S. Smith, Manish Singh, Eric Klineberg, Christopher I. Shaffrey, Virginie Lafage, Frank J. Schwab, Themistocles Protopsaltis, David Ibrahimi, Justin K. Scheer, Gregory Mundis Jr., Munish C. Gupta, Richard Hostin, Vedat Deviren, Khaled Kebaish, Robert Hart, Douglas C. Burton, Shay Bess, and Christopher P. Ames

A dults with spinal deformity characteristically experience disability and pain. 5 , 32 , 33 , 38–42 Several studies have demonstrated that one of the key drivers of pain and disability in this population is sagittal spinal malalignment. 1 , 3 , 4 , 7 , 11–13 , 15 , 18 , 19 , 22 , 26 , 27 , 29 , 40 Glassman et al. were among the first to demonstrate a clear correlation between sagittal spinal malalignment (sagittal vertical axis [SVA]) and health-related quality of life (HRQOL). 12 , 13 This correlation has been confirmed in subsequent studies

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Darryl Lau, Anthony M. DiGiorgio, Andrew K. Chan, Cecilia L. Dalle Ore, Michael S. Virk, Dean Chou, Erica F. Bisson, and Praveen V. Mummaneni

(defined as an NDI improvement < 15 points). 39 Similarly, in a series by Lanman et al., 5.6% of patients did not experience an improvement in neck pain, and 9.6% of patients did not experience improvement in arm pain. 20 Identifying factors predictive of functional outcomes following ACDF can assist in both patient selection and operative planning. In thoracolumbar deformity correction, spinal parameters such as sagittal vertical axis (SVA) and the relationship between pelvic incidence and lumbar lordosis have been shown to significantly correlate with health

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Yuji Matsuoka, Hidekazu Suzuki, Kenji Endo, Yasunobu Sawaji, Kazuma Murata, Hirosuke Nishimura, Hidetoshi Tanaka, and Kengo Yamamoto

total spinal sagittal alignment Parameter Mean ± SD C2–7 SVA (mm) 14.6 ± 10.4 CL (°) 27.6 ± 7.3 T-1 slope (°) 31.8 ± 12.6 C-7 SVA (mm) 43.8 ± 13.2 TK (°) 46.8 ± 12.2 LL (°) 15.8 ± 6.5 PT (°) 24.2 ± 11.0 PI (°) 23.1 ± 49.9 PI−LL (°) 3.0 ± 11.1 The following parameters were measured on lateral whole-spine standing radiographs preoperatively and at 1 year postoperatively: the total distance from the plumb line of the pedicle center of the C-2 vertebra to the posterior superior corner of the C-7 vertebra (C2–7 sagittal vertical axis [SVA]); cervical lordosis (CL) assessed

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Hai V. Le, Joseph B. Wick, Renaud Lafage, Gregory M. Mundis Jr., Robert K. Eastlack, Shay Bess, Douglas C. Burton, Christopher P. Ames, Justin S. Smith, Peter G. Passias, Munish C. Gupta, Virginie Lafage, Eric O. Klineberg, and

enrolled in a prospective, multicenter cervical deformity database were retrospectively reviewed. IRB approval was obtained from each participating site prior to study initiation. All patients > 18 years old who underwent CSD surgery were included. CSD was defined as any of the following: cervical kyphosis (C2–7 sagittal Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2–7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle > 25°. Patients were excluded if they did not undergo neutral lateral radiography and ELXR, or if their deformity was

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Sho Dohzono, Hiromitsu Toyoda, Tomiya Matsumoto, Akinobu Suzuki, Hidetomi Terai, and Hiroaki Nakamura

Anesthesiologists physical status was Class I for 17 patients, Class II for 66 patients, and Class III for 5 patients. A total of 79 patients underwent decompression at a single level (68 patients at L4–5, 8 at L3–4, 2 at L5–6, and 1 at L5–S1), and 9 patients underwent decompression at 2 levels (7 patients at L3–5, 1 at L2–4, and 1 at L4–S1). Patients were divided into 2 groups according to the sagittal vertical axis (SVA): a forward-bending trunk group (F group; SVA ≥ 50 mm) and a control group (C group; SVA < 50 mm; see Fig. 2 ). A total of 35 patients were allocated to

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Tomohiro Hikata, Kota Watanabe, Nobuyuki Fujita, Akio Iwanami, Naobumi Hosogane, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, and Morio Matsumoto

Cobb angles, coronal balance (C7-CSVL), sagittal balance (sagittal vertical axis [SVA]), lumbar lordosis (T12-S1), thoracic kyphosis (T5–12), thoracolumbar kyphosis (T10-L2), pelvic incidence, pelvic tilt, and sacral slope. The first author (T.H), who was not the primary surgeon, conducted the radiological measurements. Rose et al. defined the ideal sagittal balance as an SVA < 50 mm. 23 Schwab et al. demonstrated an SVA threshold of 47 mm or more for disability. 24 Therefore, we grouped patients according to preoperative SVA values < 50 mm (Group A) or ≥ 50 mm

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Dong-Ho Lee, Choon Sung Lee, Chang Ju Hwang, Jae Hwan Cho, Jae-Woo Park, and Kun-Bo Park

buckled areas of the cervical curve. 15 C2–7 sagittal vertical axis (SVA) was defined as the distance from the posterosuperior corner of C7 and a vertical line from the center of the C2 body (the point of intersection of crossing diagonals of the vertebral body). The T1 slope was measured as the angle between the upper endplate of T1 and a horizontal line. Thoracic kyphosis was measured using Cobb’s angle between the upper endplate of T1 and the lower endplate of T12. Lumbar lordosis was defined by Cobb’s angle between both upper endplates of L1 and S1. The sacral

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Sho Dohzono, Hiromitsu Toyoda, Shinji Takahashi, Tomiya Matsumoto, Akinobu Suzuki, Hidetomi Terai, and Hiroaki Nakamura

S agittal balance of the spine is important in the management of lumbar diseases and low-back pain (LBP). 1 , 9 , 10 The sagittal vertical axis (SVA) ( Fig. 1 )—defined as the deviation of the C-7 plumb line from the posterior corner of the sacrum—has been associated with health-related quality of life (QOL). 7 , 16 In patients with lumbar spinal canal stenosis (LSS), symptomatic relief is obtained by standing or walking with lumbar flexion. 20 A correlation has been reported between sagittal spinal alignment and clinical outcome in patients with lumbar