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. 2026 Feb 5.
doi: 10.1097/BRS.0000000000005648. Online ahead of print.

Analysis of Success Versus Poor Realignment in Patients with Cervical Deformity: In-Construct Angles Provide Novel Targets for Correction

Themistocles Protopsaltis  1 , Samuel Ezeonu  1 , Fares Ani  1 , Renaud Lafage  2 , Alex Soroceanu  3 , Jeffrey Gum  4 , Munish Gupta  4 , Kojo Hamilton  5 , Justin S Smith  6 , Robert Eastlack  7 , Gregory Mundis  7 , Peter Passias  8 , Han Jo Kim  9 , Richard Hostin  10 , Kal Kebaish  11 , Bassel Diebo  12 , Alan Daniels  12 , Eric Klineberg  13 , Robert Hart, Christopher Shaffrey  8 , Virginie Lafage  2 , Frank Schwab  2 , Shay Bess, Christopher Ames  14 ; and the International Spine Study Group (ISSG)
Affiliations

Analysis of Success Versus Poor Realignment in Patients with Cervical Deformity: In-Construct Angles Provide Novel Targets for Correction

Themistocles Protopsaltis et al. Spine (Phila Pa 1976). .

Abstract

Study design: Multicenter prospective study.

Objective: The present study investigates in-construct measurements of sagittal angles (SA) within the fusion from C2 to various thoracic vertebrae, which can be used as targets for CD correction.

Summary of background data: Correcting cervical deformity (CD) has the potential to significantly improve patient function. However, previously described radiographic parameters cannot be measured intraoperatively.

Methods: Patients with CD that had a LIV at T1 or caudal were included. Patients were categorized into the failed outcome group if they had a cSVA of more than 4 cm within 3 months postoperatively. The in-construct measurements were based on patients' LIV. All patients had a C2-T1 SA. C2-T4 SA were compared between groups with LIV below T4, and C2-T10 SA between groups with LIV below T10. Change in C2-LIV SA described the correction within the fusion for each patient. Linear regression analysis was used to determine the C2-T1, C2-T4, C2-T10 SA measures corresponding to a cSVA = 4 cm.HRQL analysis was done in patients with 1-year follow-up.

Results: Among 143 patients (mean age 63, 60% female), 51% had radiographic failure. Multivariate regression showed that postoperative C2-T1 SA independently predicted failed alignment (OR = 1.22, CI 1.10-1.35; P < 0.001). A cSVA of 4 cm correlated with a C2-T1 SA of -9.6° and C2-T10 SA of 14.7° (r > 0.38, P < 0.05). ΔDJKA was found to significantly correlated with the C2-T10 SA (r > 0.57, P = 0.02). Though HRQL outcomes did not differ significantly between groups, greater C2-LIV SA correction was associated with improved neck pain (r > 0.42, P = 0.036).

Conclusion: Failure to restore cSVA and development of DJK was independently associated with under correction as evidenced by significantly larger postoperative in-construct angles.

Keywords: cervical deformity; correction goals; distal junctional kyphosis; patient outcomes.

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Conflict of interest statement

Funding Disclosure: We have no conflicts of interest particular to this study. No financial support was provided for this study. Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

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