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Both anterior and posterior fusion can alter alignment, but optimal results require alignment-guided planning matched to deformity morphology and spinal flexibility. Preserving or restoring physiologic cervical alignment may lower postoperative imbalance and adjacent-segment disease risk.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/sagittal-alignment-in-cervical-spine-fusion-principles-parameters-and-surgical-implications/608684/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/sagittal-alignment-in-cervical-spine-fusion-principles-parameters-and-surgical-implications/608684.png","ImageObject",300,407,{"name":42,"@type":43},"A glass of water","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-18","2026-10-17",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"How does cervical sagittal alignment relate to disability and quality of life after cervical procedures?","Question",{"text":62,"@type":63},"Higher T1 slope–cervical lordosis mismatch and greater C2–C7 sagittal vertical axis correlate with greater disability and worse health-related quality of life. Restoring or preserving physiologic alignment is associated with improved outcomes from baseline and less risk of postoperative sagittal malalignment or adjacent-segment degeneration.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Why must cervical alignment be evaluated alongside global sagittal balance?",{"text":67,"@type":63},"Cervical posture interacts with thoracic and spinopelvic alignment and with compensatory mechanisms. Without considering global drivers, isolated cervical correction may lead to undercorrection or recurrence.",{"name":69,"@type":60,"acceptedAnswer":70},"What factors during preoperative evaluation help assess balance and compensatory strategies?",{"text":71,"@type":63},"Patients should be observed standing upright to assess horizontal gaze, cervical extension reserve, truncal inclination, pelvic retroversion, hip or knee flexion compensation, and shoulder asymmetry. Dynamic gait and functional movement assessments further help reveal balance impairment and energy expenditure.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},608684,1792339210,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":22,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145},962090760832,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","REVIEW ARTICLES  \nCURRENT CONCEPTS REVIEWS  \nSagittal Alignment in Cervical Spine Fusion Principles, Parameters, and Surgical Implications  \nBryce A. Basques, MD, MHS, Puru Sadh, BS, Jinseong Kim, MD, Bassel G. Diebo, MD, and Alan H. Daniels, MD  \nInvestigation performed at the Department of Orthopedic Surgery, Warren Alpert Medical School,  \nBrown University, Providence, Rhode Island  \n􀀁 Cervical sagittal alignment is associated with patient-reported outcomes, with higher T1 slope-cervical lordosis mismatch and greater C2-C7 sagittal vertical axis correlating with greater disability and worse health-related quality of life.  \n􀀁 Cervical alignment must be interpreted alongside global sagittal balance, as cervical posture interacts with thoracic and spinopelvic alignment and compensatory mechanisms.  \n􀀁 Both anterior and posterior cervical fusion can influence sagittal alignment, but optimal outcomes depend on alignmentconscious planning tailored to deformity morphology and spinal flexibility.  \n􀀁 Preserving or restoring physiologic cervical alignment reduces the risk of postoperative imbalance and adjacent-segment disease, supporting alignment-guided surgical decision-making.  \n\n| C | ontemporary spine research has expanded on the principles of Borelli’s On the Movement of Animals (1680), demonstrating that cervical sagittal align- | Preoperative Clinical and Radiographic Evaluation in Cervical Spine Surgery\u003Cbr>Clinical Assessment\u003Cbr>Postural and Compensatory Evaluation\u003Cbr>Patients should be observed standing upright with the head\u003Cbr>positioned as erect as possible to assess horizontal gaze, cervical extension reserve, truncal inclination, pelvic retroversion, hip or knee flexion compensation, and shoulder asymmetry5. The dynamic observation of gait and functional movement assessments also provide insight into balance impairment and energy expenditure6.\u003Cbr>The loss of cervical lordosis may trigger compensatory thoracic extension, pelvic retroversion, or lower-extremity flexion strategies to maintain upright posture7,8. Identifying these mechanisms preoperatively is critical, as isolated cervical correction without accounting for global drivers may result in undercorrection or recurrence.\u003Cbr>Patient-Reported Outcomes\u003Cbr>Patient-reported outcome measures are essential in the preoperative assessment of cervical pathology, as they quantify functional impairment and contextualize radiographic alignment within patient-centered disability. Commonly utilized |\n| --- | --- | --- |\n| ment is a critical determinant of health-related quality of life and long-term function1,2 . Across the full spectrum of cervical procedures, restoring or preserving physiologic alignment has been associated with outcomes improved from preoperative status and a reduced risk of postoperative sagittal malalignment or adjacent-segment degeneration3.\u003Cbr>Achieving surgical cervical alignment is uniquely challenging because of its complex anatomy, high mobility, and proximity to critical neurovascular structures. Anatomically, the cervical spine is the most mobile segment of the spinal column, supporting the head and allowing a wide range of motion, but this mobility comes at the cost of increased vulnerability to instability and trauma4. This makes a comprehensive understanding of cervical sagittal parameters, and of their interaction with various surgical approaches, essential. The purpose of this article is to synthesize current evidence regarding cervical alignment and translate these principles into practical, alignmentguided surgical decision-making across anterior and posterior techniques. |  |  |\n\nDisclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ([https://links.lww.com/JBJS/](https://links.lww.com/JBJS/)[ ](https://links.lww.com/JBJS/)[J537](J537)) .  \nJ Bone Joint Surg Am. [http://dx.doi.org/10.2106/JBJS.26.00362](http://dx.doi.org/10.2106/JBJS.26.00362) • Epub 2026 Oct 9  \n1  \nCopyright ©","cbCaitiYc6Qms31h","https://ap.wps.com/l/cbCaitiYc6Qms31h","pdf",1636836,11,"English","# Preoperative Clinical and Radiographic Evaluation in Cervical Spine Surgery\n## Clinical Assessment\n## Radiographic Evaluation\n## Patient-Reported Outcomes","[{\"question\":\"How does cervical sagittal alignment relate to disability and quality of life after cervical procedures?\",\"answer\":\"Higher T1 slope–cervical lordosis mismatch and greater C2–C7 sagittal vertical axis correlate with greater disability and worse health-related quality of life. Restoring or preserving physiologic alignment is associated with improved outcomes from baseline and less risk of postoperative sagittal malalignment or adjacent-segment degeneration.\"},{\"question\":\"Why must cervical alignment be evaluated alongside global sagittal balance?\",\"answer\":\"Cervical posture interacts with thoracic and spinopelvic alignment and with compensatory mechanisms. Without considering global drivers, isolated cervical correction may lead to undercorrection or recurrence.\"},{\"question\":\"What factors during preoperative evaluation help assess balance and compensatory strategies?\",\"answer\":\"Patients should be observed standing upright to assess horizontal gaze, cervical extension reserve, truncal inclination, pelvic retroversion, hip or knee flexion compensation, and shoulder asymmetry. Dynamic gait and functional movement assessments further help reveal balance impairment and energy expenditure.\"}]","Sagittal Alignment in Cervical Spine Fusion - Principles, Parameters, and Surgical Implications | PDF",1792275835,28]