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Original Articles

Basic Science

Optimal Positioning for Single-Position Lateral Lumbar Interbody Fusion
Worawat Limthongkul, Natavut Prasertkul, Pakawas Praisarnti, Maruay Tanayavong, Surachat Jaroenwareekul, Wicharn Yingsakmongkol, Weerasak Singhatanadgige, Vit Kotheeranurak
Neurospine 2026;23(1):216-225.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551540.770

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Optimal Positioning for Single-Position Lateral Lumbar Interbody Fusion
Neurospine. 2026;23(1):216-225.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551540.770
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Optimal Positioning for Single-Position Lateral Lumbar Interbody Fusion
Neurospine. 2026;23(1):216-225.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551540.770
Close
Objective
To quantify the effect of different hip positions on lumbar lordosis (LL) and spinopelvic parameters in the right lateral decubitus position (RLDP) and identify the configuration that most closely replicates physiologic standing alignment during lateral lumbar interbody fusion in minimally invasive spinal surgery.
Methods
Thirty healthy volunteers (15 males, 15 females; mean age, 27.8±8.6 years) underwent lateral lumbar radiographs in standing position and 5 RLDP configurations: neutral hips (NN), 30° flexion of both hips (30FF), 30° flexion of the right hip with left hip neutral (30FN), 60° flexion of both hips (60FF), and 60° flexion of the right hip with left hip neutral (60FN). LL, pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI) were measured. Each position was compared to standing using paired t-tests. Intra- and interobserver reliability were evaluated using intraclass correlation coefficients (ICCs).
Results
LL decreased significantly in all RLDP positions compared with standing (51.1°±3.8°). The 30FN position showed the smallest change (ΔLL=-4.9°, p<0.001), whereas 60FF showed the greatest (ΔLL=-15.0°, p<0.001). In 30FN, PT decreased (p=0.013) and SS increased (p=0.003), indicating mild anterior pelvic rotation. PI showed minimal variation across positions. Intra- and interobserver ICCs ranged from 0.92 to 0.99, confirming high measurement reliability.
Conclusion
Hip position significantly influences lumbar and pelvic alignment in RLDP. Among tested configurations, the 30FN position (right hip flexed 30°, left neutral) showed the smallest numerical deviation from standing alignment and spinopelvic harmony relative to standing in RLDP.
  • 1,592 View
  • 79 Download

Deformity

Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Xi Lin, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Morio Matsumoto, Masaya Nakamura, Kota Watanabe
Neurospine 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627

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Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Neurospine. 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627
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Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis
Neurospine. 2025;22(2):354-363.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2449254.627
Close
Objective
To examine the factors influencing cervical sagittal alignment (CSA) after posterior correction and fusion surgery (PSF) for patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).
Methods
A total of 102 female patients with Lenke 2 AIS and a minimum 2-year follow-up were included. The upper instrumented vertebra was T2 in all patients. Sagittal and coronal parameters were measured before and 2 years after surgery. Patients were categorized into cervical malalignment (CM) and noncervical malalignment (NCM) groups following Passias’ criteria. Radiographic factors influencing CSA were analyzed.
Results
Preoperatively, 57 patients (55.9%) were assigned to the CM group and 45 patients (44.1%) to the NCM groups. The cervical lordosis (CL) in CM group was more kyphotic (19.3° vs. 3.3°), smaller proximal thoracic kyphosis (PTK; 9.7° vs. 15.4°), and smaller T1 slope (7.1° vs. 14.0°) than those in the NCM group. Main thoracic kyphosis (MTK) did not show significantly difference between the 2 groups (11.3° vs. 14.4°). Two years after surgery, the CM group demonstrated significant improvements in CSA. PTK increased from 9.7° to 13.5°, T1 slope increased from 7.1° to 10.5°, and cervical kyphosis improved from -19.3° to -8.8°, while MTK remained unchanged (11.3° vs. 11.6°).
Conclusion
PSF significantly improved CSA in patients with preoperative CM. Increased PTK, correlated with improved CL, suggests that PSF-induced PTK enhancement, rather than MTK, drives T1 slope and subsequent CSA improvement.

Citations

Citations to this article as recorded by  Crossref logo
  • In Correction Surgery for Adolescent Idiopathic Scoliosis with Lenke Type 1 and 2 curves, Obtaining Kyphosis in the Upper Thoracic Spine Is Important for Preventing Postoperative Cervical Kyphosis
    Kanji Mori, Jun Takahashi, Hiroki Oba, Shinji Sasao, Shota Ikegami, Tetsuhiko Mimura, Shinji Imai
    Spine Surgery and Related Research.2026; 10(1): 89.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2025 Issue
    Inbo Han
    Neurospine.2025; 22(2): 309.     CrossRef
  • A Commentary on “Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis”
    Seung Woo Suh
    Neurospine.2025; 22(2): 364.     CrossRef
  • 3,128 View
  • 64 Download
  • 3 Crossref

Spinal Deformity

Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion
Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee
Neurospine 2024;21(4):1080-1090.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448734.367

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Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion
Neurospine. 2024;21(4):1080-1090.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448734.367
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Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion
Neurospine. 2024;21(4):1080-1090.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448734.367
Close
Objective
To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target.
Methods
The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.
Results
The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001–1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001–1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205–19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109–1.164; p<0.001) were significant risk factors for PJF development.
Conclusion
A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

Citations

Citations to this article as recorded by  Crossref logo
  • Association between lumbar lordosis and proximal junctional failure following adult spinal deformity surgery: a systematic review and meta-analysis
    Abdullah M. Alharran, AbdulMuhsen AlQallaf, Mohammad Mohammad, Mohammad Salem Alajmi, Mohammad Alkaak, Salem Y. Alenezi, Fahad Mohammad, Ahmad Al Ahmad, Nizar Algarni, Yousef Marwan
    Spine Deformity.2026;[Epub]     CrossRef
  • Utility of Enabling Technologies in Spinal Deformity Surgery: Optimizing Surgical Planning and Intraoperative Execution to Maximize Patient Outcomes
    Nora C. Kim, Eli Johnson, Christopher DeWald, Nathan Lee, Timothy Y. Wang
    Journal of Clinical Medicine.2025; 14(15): 5377.     CrossRef
  • Postoperative L1 Tilt as a Predictor of Proximal Junctional Kyphosis Following Lower Thoracic Spine-to-Pelvis Fusion for Adult Spinal Deformity
    Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Kyunghun Jung, Minwook Kang, Chong-Suh Lee
    Spine.2025; 50(24): 1769.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2024 Issue
    Inbo Han
    Neurospine.2024; 21(4): 1051.     CrossRef
  • Risk Factors, Biomechanics, and Prevention Strategies for Proximal Junctional Failure in Adult Spinal Deformity Surgery – A Commentary on “Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignm
    Lee A. Tan
    Neurospine.2024; 21(4): 1094.     CrossRef
  • New Insights Into Risk Factors for Proximal Junctional Failure in Adult Spinal Deformity Surgery – A Commentary on “Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients
    Masayuki Miyagi, Gen Inoue, Masashi Takaso
    Neurospine.2024; 21(4): 1091.     CrossRef
  • 6,693 View
  • 290 Download
  • 6 Crossref
Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Myung Woo Park, Sang Jun Park, Sun Gun Chung
Neurospine 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247

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Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Neurospine. 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247
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Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly
Neurospine. 2023;20(3):959-968.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346494.247
Close
Objective
Loss of skeletal muscle mass is known to be associated with multiple morbidities. However, there is a dearth of reports on its association with lumbar lordosis and musculoskeletal pain. The aim of this study was to delineate the cross-sectional relationship between loss of skeletal muscle mass, lumbar lordosis, and chronic low back pain (CLBP).
Methods
A total of 721 medical records were reviewed, and data from 165 older subjects (over 65 years old; 81 men and 84 women) were retrospectively analyzed. Subjects were categorized into either the CLBP group (back pain for more than 6 months; 35 men and 36 women) or the control group (46 men and 48 women). The modified skeletal muscle mass index (MSMI, appendicular skeletal muscle mass [kg]/weight [kg] × 100), assessed by bioelectrical impedance analysis, and lumbar lordotic angle (LLA) were measured and compared between the CLBP group and the control group. The correlation between MSMI and LLA was investigated.
Results
The LLA of men and women in the CLBP group was significantly lower than that of the control group (p < 0.05). The MSMI was decreased in the CLBP group compared to the control group (p < 0.05). For both sexes, positive correlations were observed between the MSMI and LLA.
Conclusion
A close cross-sectional relationship was observed between MSMI, LLA, and CLBP. This suggests a potential interaction between the reduction in skeletal muscle mass and altered lumbar spine sagittal alignment, which could lead to CLBP.

Citations

Citations to this article as recorded by  Crossref logo
  • Improvement in low back pain following endoscopic decompression for spinal stenosis
    Maria Auron, Yihyun Roh, Maria C. Pedraza Ciro, Win Boonsirikamchai, Yi-Hao Liang, Jung Hoon Kim, Jin-Sung Kim
    Brain and Spine.2026; 6: 105995.     CrossRef
  • Sarcopenia as a risk factor for incident pain in Chinese middle-aged and older adults: longitudinal evidence from the CHARLS cohort
    Xin Zhang, Xiaowei Li, Heng Li, Zhiyong Xiao, Rui Qu, Jianwei Zhou
    The Journal of nutrition, health and aging.2026; 30(4): 100811.     CrossRef
  • The Effect of Core Stability Exercise on the Change in Kinesiophobia Among the Elderly with Chronic Non-specific Low Back Pain
    Shofiyah Izdihar Binauf, Faizah Abdullah Djawas
    KnE Social Sciences.2026; 11(3): 103.     CrossRef
  • Association of Lumbar Sagittal Curvature Profiles with Musculoskeletal Disorders: A Pilot Radiographic Study
    Yu-Li Wang, Shu-Wei Huang, Hsuan-Yu Chen, Kuei-Chen Lee, Chao-Min Cheng
    Diagnostics.2026; 16(9): 1291.     CrossRef
  • Symptomatic Hand Osteoarthritis in Healthy Older Women: A Preliminary Cross-Sectional Analysis Using Body Composition
    Nobuaki Suzuki, Takuya Yoda, Masato Nakadai, Takehito Takano, Kei Watanabe, Hiroyuki Kawashima
    Journal of Orthopaedics.2026;[Epub]     CrossRef
  • Sex-Specific Influence of Preoperative Musculoskeletal Characteristics on Postoperative Outcomes in Lumbar Spinal Surgery: A Prospective Cohort Study
    Seungjun Ryu, Danbi Park, Ji Yeon Baek, Chongman Kim, Hong Kyung Shin, Sun Woo Jang, Jeoung Hee Kim, Sung Woo Roh, Jin Hoon Park
    World Neurosurgery.2025; 194: 123435.     CrossRef
  • Does Paraspinal Muscle Mass Predict Lumbar Lordosis Before and After Decompression for Degenerative Spinal Stenosis?
    Rajkishen Narayanan, Teeto Ezeonu, Alec Kellish, Sydney Somers, Yunsoo Lee, Akshay Khanna, Anthony Labarbiera, Sebastian Fras, Jose A. Canseco, Mark F. Kurd, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher Kepler, Gregory D. Schroeder
    Spine.2025; 50(2): E29.     CrossRef
  • Global, regional, and national burden of low back pain for adults aged 55 and older 1990–2021: an analysis for the global burden of disease study 2021
    Shangbo Xu, Jiaxin Chen, Chicheng Wang, Ye Lin, Weipeng Huang, Haoyue Zhou, Weibiao Ji, Yangbo Chen
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Association Between Lumbar Lordosis, Thoracic Kyphosis, and Muscle Activations During Different Lower Back Exercises: An Observational Study
    Emre Serdar Atalay, Duygu Türker, Çağlar Soylu, Tezel Yıldırım Şahan, Necmiye Ün Yıldırım
    Medicina.2025; 61(6): 986.     CrossRef
  • Varying effectiveness of real-time biofeedback across various activities in preserving lumbar Lordotic curvature using an inertial measurement system
    Ju Chan Kim, Byung Ju Cho, Hui Dong Lim, Keewon Kim, Sun Gun Chung
    Scientific Reports.2025;[Epub]     CrossRef
  • The relationship between muscle mass and low back pain: a cross-sectional study
    Rudong Chen, Congwen Yang, Xiaofu Tang, Shijie Han, Mingjie Kuang, Xiaoming Li
    European Spine Journal.2025; 34(7): 2597.     CrossRef
  • Relationships between psoas muscle index, lumbar lordosis, and chronic low back pain in middle-aged and elderly people
    Bin Zhang, Peng Song, Chao Ma, Yan Xu, Yan Yuan
    European Spine Journal.2025; 34(7): 2511.     CrossRef
  • Effectiveness of a Facet Joint Block Versus a Medial Branch Block in Spinal Pain Management: A Systematic Review and Meta-Analysis
    Sung Hyeon Noh, Kyoung-Tae Kim, Dong Ah Shin, Je Hwi Yun, Pyung Goo Cho, Sang Hyun Kim
    Neurospine.2025; 22(2): 441.     CrossRef
  • Advances in Therapeutic Applications of CRISPR Genome Editing for Spinal Pain Management
    Chan Young Kang, Kyung Wook Been, Myoung-Hee Kang, Myung Su Choi, Rae Hee Kang, Junseok W. Hur, Junho K. Hur
    Neurospine.2025; 22(2): 421.     CrossRef
  • Current Concepts on Imaging and Artificial Intelligence of Osteosarcopenia in the Aging Spine: A Review for Spinal Surgeons by the SRS Adult Spinal Deformity Task Force on Senescence
    Corey T. Walker, Robin Babadjouni, Wende Gibbs, Elizabeth Lord, Adeesya Gausper, Joseph Osorio, Camilo Molina, Kristen Jones, Miranda van Hooff, Alexander Theologis, Mitsuru Yagi, Laurel Blakemore, Suken Shah, Serena Hu, Marinus de Kleuver, Javier Pizones
    Spine.2025; 50(18): 1278.     CrossRef
  • Determination of the relationship between lumbar lordosis and demographic/clinical characteristics of patients with chronic low back pain
    Hamza M Shaheen, Beliz Belgen Kaygisiz
    Fizjoterapia Polska.2025; 25(4): 74.     CrossRef
  • Enhanced disc regeneration through CRISPR/Cas9-mediated SOX9 and TGFβ1 coexpression in tonsil-derived mesenchymal stromal cells
    Somin Lee, Yerin Yu, Dong hee Kim, Minsung Bock, Yeji Kim, Seong Bae An, Hyemin Choi, Hae Eun Shin, Dong-Youn Hwang, Inbo Han
    Stem Cell Research & Therapy.2025;[Epub]     CrossRef
  • Correlation Between Spinopelvic Sagittal Alignment Parameters and Low Back Pain
    Muhammad Bilal, Faizan Ali Janjua, Abdullah Jan, Asif Ali Jatoi, Muhammad Asad Qureshi, Ejaz Aslam
    Pakistan Journal of Health Sciences.2025; : 20.     CrossRef
  • Lumbar fusion surgery in the era of an aging society: analysis of a nationwide population cohort with minimum 8-year follow-up
    Woo-Keun Kwon, Alekos A. Theologis, Joo Han Kim, Hong Joo Moon
    The Spine Journal.2024; 24(8): 1378.     CrossRef
  • Genetically predicted causal effects of gut microbiota on spinal pain: a two-sample Mendelian randomization analysis
    Shuangwei Hong, Longhao Chen, Xingchen Zhou, Yuanshen Huang, Yu Tian, Huijie Hu, Bei Yu, Hongjiao Wu, Chao Yang, Zhizhen Lv, Lijiang Lv
    Frontiers in Microbiology.2024;[Epub]     CrossRef
  • Causal associations between sarcopenia-related traits and intervertebral disc degeneration: a two-sample mendelian randomization analysis
    Weihui Qi, Zhenglin Mei, Xinning Mao, Li Zhu, Yinyan Shao, Guofen Ge, Wei Zhang, Hao Pan, Dong Wang
    European Spine Journal.2024; 33(6): 2430.     CrossRef
  • Stem Cell and Regenerative Therapies for the Treatment of Osteoporotic Vertebral Compression Fractures
    Songzi Zhang, Yunhwan Lee, Yanting Liu, Yerin Yu, Inbo Han
    International Journal of Molecular Sciences.2024; 25(9): 4979.     CrossRef
  • Comparison of the effectiveness of zero-profile device and plate cage construct in the treatment of one-level cervical disc degenerative disease combined with moderate to severe paraspinal muscle degeneration
    Haimiti Abudouaini, Hui Xu, Junsong Yang, Mengbing Yi, Kaiyuan Lin, Sibo Wang
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • 8,773 View
  • 262 Download
  • 18 Web of Science
  • 23 Crossref

CSRS Special Issue

The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion
Akiro H. Duey, Christopher Gonzalez, Eric A. Geng, Pierce J. Ferriter Jr, Ashley M. Rosenberg, Ula N. Isleem, Bashar Zaidat, Paul M. Al-Attar, Jonathan S. Markowitz, Jun S. Kim, Samuel K. Cho
Neurospine 2022;19(4):927-934.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244750.375

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The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion
Neurospine. 2022;19(4):927-934.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244750.375
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The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion
Neurospine. 2022;19(4):927-934.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244750.375
Close
Objective
Subsidence following anterior cervical discectomy and fusion (ACDF) may lead to disruptions of cervical alignment and lordosis. The purpose of this study was to evaluate the effect of subsidence on segmental, regional, and global lordosis.
Methods
This was a retrospective cohort study performed between 2016–2021 at a single institution. All measurements were performed using lateral cervical radiographs at the immediate postoperative period and at final follow-up greater than 6 months after surgery. Associations between subsidence and segmental lordosis, total fused lordosis, C2–7 lordosis, and cervical sagittal vertical alignment change were determined using Pearson correlation and multivariate logistic regression analyses.
Results
One hundred thirty-one patients and 244 levels were included in the study. There were 41 one-level fusions, 67 two-level fusions, and 23 three-level fusions. The median follow-up time was 366 days (interquartile range, 239–566 days). Segmental subsidence was significantly negatively associated with segmental lordosis change in the Pearson (r = -0.154, p = 0.016) and multivariate analyses (beta = -3.78; 95% confidence interval, -7.15 to -0.42; p = 0.028) but no associations between segmental or total fused subsidence and any other measures of cervical alignment were observed.
Conclusion
We found that subsidence is associated with segmental lordosis loss 6 months following ACDF. Surgeons should minimize subsidence to prevent long-term clinical symptoms associated with poor cervical alignment.

Citations

Citations to this article as recorded by  Crossref logo
  • Impact of cage type on subsidence following anterior cervical discectomy and fusion: a retrospective study
    Pierce J. Ferriter Jr, Suhas K. Etigunta, Akiro H. Duey, Christopher Gonzalez, Katrina Nietsch, Ashley M. Rosenberg, Bashar Zaidat, Avanish Yendluri, Daniel Berman, Junho Song, Jun S. Kim, Samuel K. Cho
    Asian Spine Journal.2026; 20(1): 87.     CrossRef
  • Radiological Factors Affecting Cage Subsidence after Single-level Anterior Cervical Discectomy and Fusion with Double Titanium Cylindrical Cages
    Toshiyuki OKAZAKI, Kazuma DOI, Kazunori SHIBAMOTO, Satoshi TANI, Junichi MIZUNO
    Neurologia medico-chirurgica.2026; 66(1): 7.     CrossRef
  • Development and validation of a nomogram prediction model for assessing cage subsidence risk following anterior cervical discectomy and fusion
    Dongmei Zhao, Xiaojie Sun
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • Loss of Lordosis at C5–7 Following 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Subsequent Reoperations
    Manjot Singh, Alejandro Perez-Albela, Puru Sadh, Ishan Shah, Timothy Jeng, Charles Furlong, Alan H. Daniels, Bryce A. Basques
    Clinical Spine Surgery.2026;[Epub]     CrossRef
  • Evaluation of a Novel Flexible Cage System for C5–C6 Fixation: A Finite Element Study Against Conventional ACDF Implants
    Seongho Woo, Won Mo Koo, Kinam Park, Jong-Moon Hwang, Sungwook Kang
    Bioengineering.2026; 13(4): 375.     CrossRef
  • Cervical Lordosis Correction and Segmental Height in Anterior Cervical Surgeries; The Role of Implant Choice
    Ahmet Serhat Eroğlu, Oğuz Kağan Demirtaş
    World Neurosurgery.2025; 193: 613.     CrossRef
  • Predictors of Implant Subsidence and Its Impact on Cervical Alignment Following Anterior Cervical Discectomy and Fusion: A Retrospective Study
    Rose Fluss, Alireza Karandish, Rebecca Della Croce, Sertac Kirnaz, Vanessa Ruiz, Rafael De La Garza Ramos, Saikiran G. Murthy, Reza Yassari, Yaroslav Gelfand
    Journal of Clinical Medicine.2025; 14(16): 5660.     CrossRef
  • Comparison of expandable and titanium cages in anterior cervical corpectomy for OPLL with osteoporosis: A retrospective matched study
    Yaqi Li, Kexi Yang, Zhancheng Liang, Jialing Liang, Hanhui Liu
    Medicine.2025; 104(37): e44227.     CrossRef
  • Role of preoperative Hounsfield units in predicting subsidence after anterior cervical discectomy and fusion in the United States: a retrospective analysis including osteopenia diagnosis
    Wasil Ahmed, Akiro Duey, Rami Rajjoub, Timothy Hoang, Bashar Zaidat, Zachary Milestone, Jiwoo Park, Christopher Gonzalez, Pierce Jr. Ferriter, Junho Song, Jun Kim, Samuel Cho
    Asian Spine Journal.2025; 19(4): 609.     CrossRef
  • The Clinical Management of Professional Mixed Martial Arts Athletes Returning to Play after ACDF
    Taesung Kim, YuanDian Zheng, Eric Twohey, Etienne Rossert, John Neidecker
    Current Sports Medicine Reports.2025; 24(10): 330.     CrossRef
  • Deciphering subsidence risk after ACDF: a biomechanical study on bone density and endplate thickness
    Guiyu Liu, Jinyang Zhang, Xiangqian Tian, Fasheng He, Xiandong Sun, Liangxiu Xiao
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Safety and Efficacy of Zero-Profile Polyetheretherketone (PEEK) Cages Filled with Biphasic Calcium Phosphate (BCP) in Anterior Cervical Discectomy and Fusion (ACDF): A Case Series
    Marco Battistelli, Edoardo Mazzucchi, Mario Muselli, Gianluca Galieri, Filippo Maria Polli, Fabrizio Pignotti, Alessandro Olivi, Giovanni Sabatino, Giuseppe La Rocca
    Journal of Clinical Medicine.2024; 13(7): 1919.     CrossRef
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    Soubach Saravanan, Jean Yves Fournier, Alexandre Simonin
    Neurospine.2024; 21(4): 1168.     CrossRef
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    Chang Hwa Ham, Joo Han Kim, Youn-Kwan Park, Woo-Keun Kwon, Hong Joo Moon
    Neurospine.2024; 21(4): 1241.     CrossRef
  • Radiographic outcomes and subsidence rate in hyperlordotic versus standard lordotic interbody spacers in patients undergoing anterior cervical discectomy and fusion
    Rajkishen Narayanan, Nicholas B. Pohl, Jonathan Dalton, Yunsoo Lee, Alexa Tomlak, Anthony Labarbiera, Meryem Guler, Emilie Sawicki, Sebastian I. Fras, Mark F. Kurd, John J. Mangan, Ian David Kaye, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro,
    Journal of Craniovertebral Junction and Spine.2024; 15(4): 475.     CrossRef
  • Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Complications and Pitfalls
    Dong-Ho Lee, Sung Tan Cho, Sehan Park, Chang Ju Hwang, Jae Hwan Cho, Jin Hwan Kim
    Neurospine.2023; 20(2): 669.     CrossRef
  • Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis
    Jung Hwan Lee, Youn Joo Lee, Min Cheol Chang, Jun Ho Lee
    Neurospine.2023; 20(3): 1047.     CrossRef
  • Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling
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    Scientific Reports.2023;[Epub]     CrossRef
  • 8,532 View
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  • 19 Web of Science
  • 18 Crossref

CSRS Special Issue

Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim
Neurospine 2022;19(4):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302

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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302
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Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Neurospine. 2022;19(4):912-920.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244604.302
Close
Objective
C2 slope (C2S), a cervical parameter mathematically approximated as T1 slope minus cervical lordosis (T1S–CL), predicts functional improvement in cervical deformity patients. Nonetheless, C2S is a positional parameter based only on the horizontal axis. The current study aims to introduce novel odontoid parameters and establish their relationships with patient-reported health-related quality of life (HRQoL).
Methods
Lateral plain radiographs of 32 adults who underwent multilevel posterior cervical fusion were analyzed. The odontoid parameters included odontoid incidence (OI), C2S, odontoid tilt (OT), and gravity line-C2 distance (GL-C2), while the cervical parameters were the Cobb angle at C0–1, C1–2, C0–2, C2–7, C2–7 sagittal vertical axis (cSVA), T1 slope, and T1S–CL. The range of motion (ROM) of the occipito-atlantoaxial complex was measured in flexion and extension plain radiographs. Scores on the Neck Disability Index (NDI) and visual analogue scale (VAS) for axial neck (VASn) and arm pain were measured.
Results
Compared to asymptomatic subjects, patients had larger C2S, cSVA, and T1S–CL, and smaller OT. Preoperatively, OI was significantly correlated with the ROM of C1–2 (r = 0.37, p < 0.05) and C0–2 (r = 0.46, p < 0.01). OT and C2S had significant correlations with the C0–1, C1–2, and C0–2 angles, GL-C2, and T1S–CL. Postoperative NDI scores were significantly correlated with OI (r = -0.40, p < 0.05) and OT (ρ = -0.37, p < 0.05). VASn was significantly correlated with GL-C2 (r = -0.35, p < 0.05).
Conclusion
The odontoid parameters were significantly correlated with established cervical parameters and HRQoL measures. OI is a constant parameter representing the individual's compensatory reservoir at the upper cervical spine.

Citations

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  • Odontoid Parameters in Adolescent Idiopathic Scoliosis Patients
    Qiong-run Xiao, Long-ao Huang, Ke-lin Li, Yu-wang Du, Xiao Liang, Chong-yang Wang, Hua Jiang
    Clinical Spine Surgery.2026; 39(2): E74.     CrossRef
  • The effect of cervical spine flexion-extension motion on odontoid parameters
    Longao Huang, Dun Liu, Hongyuan Xu, Junfei Feng, Tao Kang, Shengwang Wei, Hua Jiang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion
    Yan Gong, Hao Liu, Yanchi Gan, Jiahui He, Zelin Zhou, Hang Zhuo, Yu Liu, De Liang, Hui Ren, Xiaobing Jiang, Zhaojun Cheng
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion (ACCF): retrospective study of 102 patients with minimum 2-year follow-up
    Haoxiang Wang, Tian Xia, Ruomu Qu, Hanbo Geng, Yu Sun, Fengshan Zhang, Shengfa Pan, Xin Chen, Yanbin Zhao, Feifei Zhou
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Impact of anterior controllable antedisplacement and fusion (ACAF) on cervical lordosis and sagittal alignment in OPLL: A comparative radiographic analysis
    Shunmin Wang, Dong Liu, Jincui Li, Jingchuan Sun, Tiefeng Li, Jiangang Shi
    Journal of Orthopaedics.2025; 70: 158.     CrossRef
  • Odontoid parameters in subjects with and without degenerative cervical spondylosis
    Tao Kang, Weiyou Chen, Longao Huang, Hongyuan Xu, Hua Jiang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Introducing the Modified Cobb Angle for Measuring Cervical Spine Curvature During Swallowing
    Catriona M. Steele, Makaya O' Grady, Sima Farpour, Melanie Peladeau‐Pigeon, Sophia Werden Abrams, Maureen Folsom, Emily K. Plowman, Ashwini M. Namasivayam‐MacDonald
    Laryngoscope Investigative Otolaryngology.2025;[Epub]     CrossRef
  • The Significance of Odontoid Incidence in Patients With Cervical Spondylotic Myelopathy
    Hongyu Qin, Weiyou Chen, Longao Huang, Xin Xiao, Qinghua Yang, Hua Jiang
    Global Spine Journal.2024; 14(8): 2374.     CrossRef
  • Variation of Odontoid Incidence According to Age in Asymptomatic Children
    Yuwang Du, Weiyou Chen, Hongyuan Xu, Xiao Liang, Chongyang Wang, Hongyu Qin, Hua Jiang
    World Neurosurgery.2024; 190: e496.     CrossRef
  • Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Proced
    Junho Mun, Seung-Jae Hyun, Jae-Koo Lee, Sungjae An, Ki-Jeong Kim
    Neurospine.2023; 20(3): 981.     CrossRef
  • Selection of Optimal Lower Instrumented Vertebra for Adolescent Idiopathic Scoliosis Surgery
    Seung-Ho Seo, Seung-Jae Hyun, Jae-Koo Lee, Yong Jae Cho, Dae Jean Jo, Jin Hoon Park, Ki-Jeong Kim
    Neurospine.2023; 20(3): 799.     CrossRef
  • Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets
    Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
    Neurospine.2023; 20(4): 1246.     CrossRef
  • Commentary on “Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery”
    Sang Hun Lee
    Neurospine.2022; 19(4): 921.     CrossRef
  • Significance of Atlantoaxial and Subaxial Spinal Instability in Cervical Spinal Spondylosis: Commentary on “Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery”
    Atul Goel
    Neurospine.2022; 19(4): 924.     CrossRef
  • 6,485 View
  • 208 Download
  • 14 Crossref
Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
Neurospine 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110

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Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Neurospine. 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110
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Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
Neurospine. 2022;19(2):463-471.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244220.110
Close
Objective
By using angulation of the axis itself, this study aims to define and analyze odontoid incidence (OI) and odontoid tilt (OT) as novel cervical alignment parameters and investigate their correlations with cervical alignment.
Methods
Novel and existing parameters were measured with whole-spine lateral plain radiographs and EOS images of 42 adults without cervical symptoms. The correlations of OI, OT, C2 slope (C2S), and T1 slope (T1S) were calculated.
Results
The OI, OT, and C2S showed significant correlations with C2–7 angle (r = 0.43, r = -0.42, r = 0.62, respectively) and C0–2 angle (r = -0.33, r = 0.48, r = -0.61, respectively). OI, OT, T1S were independent predictors of the C2–7 angle in univariate regression analysis (adjusted-R2 = 0.17, R2 = 0.15, R2 = 0.28, respectively). OI, OT, and T1S were independent predictors in the multivariable regression analysis with estimated standardized coefficients of 0.36, -0.67, -0.69, respectively (adjusted- R2 = 0.80, p < 0.001). Regarding the C0–2 angle, OI and OT were independent predictors in the univariate regression analysis (adjusted-R2 = 0.08, R2 = 0.21, respectively).
Conclusion
OI, OT, and C2S had significant correlations with cervical alignment. As the pelvic incidence, the OI is the only anatomical and constant parameter that could be used as a reference point related to the cervical spine from the rostral end. The study results may serve as baseline data for further studies on the alignment and balance of the cervical spine.

Citations

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  • Odontoid Parameters in Adolescent Idiopathic Scoliosis Patients
    Qiong-run Xiao, Long-ao Huang, Ke-lin Li, Yu-wang Du, Xiao Liang, Chong-yang Wang, Hua Jiang
    Clinical Spine Surgery.2026; 39(2): E74.     CrossRef
  • Investigation of the effects of odontoid bone anatomical location and structure on cervical lordosis angle in cervical ct examinations: A clinical study
    Alemiddin Ozdemir, Ahmet Melih Erdogan, Ozge Sevimoglu, Buket Oguz, Buse Kaymakci, Selma Caliskan, Bulent Bakar
    Medical Journal of Western Black Sea.2026;[Epub]     CrossRef
  • Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion
    Yan Gong, Hao Liu, Yanchi Gan, Jiahui He, Zelin Zhou, Hang Zhuo, Yu Liu, De Liang, Hui Ren, Xiaobing Jiang, Zhaojun Cheng
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • The effect of cervical spine flexion-extension motion on odontoid parameters
    Longao Huang, Dun Liu, Hongyuan Xu, Junfei Feng, Tao Kang, Shengwang Wei, Hua Jiang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Odontoid parameters in subjects with and without degenerative cervical spondylosis
    Tao Kang, Weiyou Chen, Longao Huang, Hongyuan Xu, Hua Jiang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Assessment of posterior odontoid tilt: Think scoliosis
    Neel Raja, Elias Petrou, Sonal Saran, Hasaam Uldin, Morgan Jones, Fahid Rasul, Kapil Shirodkar, Shashank Chapala, Rajesh Botchu
    Journal of Craniovertebral Junction and Spine.2025; 16(3): 278.     CrossRef
  • The Significance of Odontoid Incidence in Patients With Cervical Spondylotic Myelopathy
    Hongyu Qin, Weiyou Chen, Longao Huang, Xin Xiao, Qinghua Yang, Hua Jiang
    Global Spine Journal.2024; 14(8): 2374.     CrossRef
  • Variation of Odontoid Incidence According to Age in Asymptomatic Children
    Yuwang Du, Weiyou Chen, Hongyuan Xu, Xiao Liang, Chongyang Wang, Hongyu Qin, Hua Jiang
    World Neurosurgery.2024; 190: e496.     CrossRef
  • Odontoid incidence: a constant cervical anatomical feature evident in standing plain radiographs and supine magnetic resonance images
    Longao Huang, Weiyou Chen, Hongyuan Xu, Hongyu Qin, Hua Jiang
    Journal of Orthopaedic Surgery and Research.2024;[Epub]     CrossRef
  • Atlantoaxial Instability in the Course of Rheumatoid Arthritis in Relation to Selected Parameters of Sagittal Balance
    Robert Wróblewski, Małgorzata Mańczak, Robert Gasik
    Journal of Clinical Medicine.2024; 13(15): 4441.     CrossRef
  • Analysis of odontoid parameters in adolescent idiopathic scoliosis patients with different curve types
    Kelin Li, Longao Huang, Qiongrun Xiao, Weiyou Chen, Yuwang Du, Hua Jiang
    Frontiers in Pediatrics.2024;[Epub]     CrossRef
  • Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Proced
    Junho Mun, Seung-Jae Hyun, Jae-Koo Lee, Sungjae An, Ki-Jeong Kim
    Neurospine.2023; 20(3): 981.     CrossRef
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    Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim
    Neurospine.2022; 19(4): 853.     CrossRef
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    Sang Hun Lee
    Neurospine.2022; 19(4): 921.     CrossRef
  • Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
    Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim
    Neurospine.2022; 19(4): 912.     CrossRef
  • 7,851 View
  • 233 Download
  • 14 Web of Science
  • 15 Crossref
Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study
Bernardo de Andrada Pereira, Anna G.U. Sawa, Jakub Godzik, Jennifer N. Lehrman, Juan S. Uribe, Jay D. Turner, Brian P. Kelly
Neurospine 2021;18(3):635-643.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142368.184

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Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study
Neurospine. 2021;18(3):635-643.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142368.184
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Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study
Neurospine. 2021;18(3):635-643.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2142368.184
Close
Objective
The lordotic shape of the lumbar spine differs substantially between individuals. Measuring and recording strain during spinal biomechanical tests is an effective method to infer stresses on spinal implants and predict failure mechanisms. The geometry of the spine may have a significant effect on the resultant force distribution, thereby directly affecting rod strain.
Methods
Seven fresh-frozen cadaveric specimens (T12-sacrum) underwent standard (7.5 Nm) nondestructive sagittal plane tests: flexion and extension. The conditions tested were intact and pedicle screws and rods (PSR) at L1-sacrum. The posterior right rod was instrumented with strain gauges between L3–4 (index level) and the L5–S1 pedicle screw. All specimens underwent lateral radiographs before testing. Lordotic angles encompassing different levels (L5–S1, L4–S1, L3–S1, L2–S1, and L1–S1) were measured and compared with rod strain. Data were analyzed using Pearson correlation analyses.
Results
Strong positive correlations were observed between lordosis and posterior rod strain across different conditions. The L3–S1 lordotic angle in the unloaded intact condition correlated with peak rod strain at L3–4 with PSR during flexion (R = 0.76, p = 0.04). The same angle in the unloaded PSR condition correlated with peak strain in the PSR condition during extension (R = -0.79, p = 0.04). The unloaded intact L2–S1 lordotic angle was significantly correlated with rod strain at L3–4 in the PSR condition during flexion (R = 0.85, p = 0.02) and extension (R = -0.85, p = 0.02) and with rod strain at L5–S1 in the PSR condition during flexion (R = 0.84, p = 0.04).
Conclusion
Lordosis measured on intact and instrumented conditions has strong positive correlations with posterior rod strain in cadaveric testing.

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    Ibrahim M. Moustafa, Dilber Uzun Ozsahin, Mubarak Taiwo Mustapha, Shima Zadeh, Iman Khowailed, Paul A. Oakley, Deed E. Harrison
    Scientific Reports.2026;[Epub]     CrossRef
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    Kari Odland, Christopher T. Martin
    Seminars in Spine Surgery.2026; : 101254.     CrossRef
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    Maximilian Heumann, Chencheng Feng, Lorin M. Benneker, Maarten Spruit, Christian Mazel, Jan Buschbaum, Boyko Gueorguiev, Manuela Ernst
    Medical Engineering & Physics.2025; 139: 104339.     CrossRef
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    Lijin Zhou, Honghao Yang, Jie Wang, Yiqi Zhang, Yunsheng Wang, Yong Hai
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
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    Jiangkai Yu, Cong Zhang, Yan Zhou, Chengming Li
    European Journal of Medical Research.2025;[Epub]     CrossRef
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    Niloufar Shekouhi, Sudharshan Tripathi, Vijay K. Goel, Alekos A. Theologis
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    Clinical Biomechanics.2024; 114: 106239.     CrossRef
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    Nathan J. Lee, Paul J. Park, Varun Puvanesarajah, William E. Clifton, Kevin Kwan, Cole R. Morrissette, Jaques L. Williams, Michael W. Fields, Eric Leung, Fthimnir M. Hassan, Peter D. Angevine, Christopher E. Mandigo, Joseph M. Lombardi, Zeeshan M. Sardar,
    Journal of Neurosurgery: Spine.2023; 38(1): 91.     CrossRef
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    Simone Borrelli, Giovanni Putame, Alberto L. Audenino, Cristina Bignardi, Andrea Ferro, Stefano Marone, Mara Terzini
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    Hyun-Seo Cho, Se-Hoon Kim, Jeong Su Han, Bum-Joon Kim
    World Neurosurgery.2023; 175: e1307.     CrossRef
  • Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery
    Shin Won Kwon, Chun Kee Chung, Young Il Won, Woon Tak Yuh, Sung Bae Park, Seung Heon Yang, Chang Hyun Lee, John M. Rhee, Kyoung-Tae Kim, Chi Heon Kim
    Neurospine.2022; 19(1): 146.     CrossRef
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    Nathan J. Lee, Gerard Marciano, Varun Puvanesarajah, Paul J. Park, William E. Clifton, Kevin Kwan, Cole R. Morrissette, Jaques L. Williams, Michael Fields, Fthimnir M. Hassan, Peter D. Angevine, Christopher E. Mandigo, Joseph M. Lombardi, Zeeshan M. Sarda
    Journal of Neurosurgery: Spine.2022; : 1.     CrossRef
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Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?
Tanvir Johanning Bari, Martin Heegaard, Rachid Bech-Azeddine, Benny Dahl, Martin Gehrchen
Neurospine 2021;18(3):543-553.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2040744.372

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Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?
Neurospine. 2021;18(3):543-553.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2040744.372
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Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?
Neurospine. 2021;18(3):543-553.   Published online September 30, 2021
DOI: https://doi.org/10.14245/ns.2040744.372
Close
Objective
The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribution. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribution was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion.
Methods
All patients undergoing fusion surgery ( ≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: “normal” (LDI 50–80), “hypolordotic” (LDI < 50), or “hyperlordotic” (LDI > 80).
Results
We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI–LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subsequent multivariable logistic regression showed increased odds of 1-year revision in the hypolordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001).
Conclusion
In patients undergoing instrumented lumbar fusion surgery, hypolordotic lordosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI–LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.

Citations

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  • The Use of a Wilson Kyphosis Frame Results in Minimal Loss of Lordosis Correction after Single Level Minimally Invasive TLIF at L4-5 or L5-S1
    Mitchell S. Fourman, Keith Lyons, Kasra Araghi, J. Manuel Sarmiento, Sidhant Dalal, Dan Shinn, Junho Song, Pratyush Shahi, Dimitra Melissaridou, Evan Sheha, Sravisht Iyer, James Dowdell, Sheeraz Qureshi
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    Pierre Barthes, André Boché, Richard Lacroix, Cécile Swennen, Mathieu Severyns, Clément Giraud, Tanguy Vendeuvre
    Cureus.2026;[Epub]     CrossRef
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    Young-Gook Gwak, Myung-Hoon Shin
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    Abdullah M. Alharran, AbdulMuhsen AlQallaf, Mohammad Mohammad, Mohammad Salem Alajmi, Mohammad Alkaak, Salem Y. Alenezi, Fahad Mohammad, Ahmad Al Ahmad, Nizar Algarni, Yousef Marwan
    Spine Deformity.2026;[Epub]     CrossRef
  • How Does the Lordosis Apex, Lordosis Arcs, and Inflection Point According to Roussouly Predict Outcomes After Adult Spinal Deformity Surgery?
    Harsh Jain, Advith Sarikonda, Hani Chanbour, Iyan Younus, Tyler Zeoli, Adam M. Wegner, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman
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Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty
Kosei Ono, Sohei Murata, Mutsumi Matsushita, Hiroshi Murakami
Neurospine 2021;18(2):311-318.   Published online January 22, 2021
DOI: https://doi.org/10.14245/ns.2040700.350

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Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty
Neurospine. 2021;18(2):311-318.   Published online January 22, 2021
DOI: https://doi.org/10.14245/ns.2040700.350
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Cervical Lordosis Ratio as a Novel Predictor for the Loss of Cervical Lordosis After Laminoplasty
Neurospine. 2021;18(2):311-318.   Published online January 22, 2021
DOI: https://doi.org/10.14245/ns.2040700.350
Close
Objective
Maintaining cervical lordosis (CL) after laminoplasty is important for indirect decompression of the spinal cord. This study aimed to identify preoperative dynamic radiographic predictors for the loss of CL after laminoplasty.
Methods
We retrospectively analyzed 141 consecutive patients who underwent cervical laminoplasty for cervical myelopathy. The following radiographic parameters were measured before surgery and at 1 year of follow-up: CL, C7 slope, C2–7 sagittal vertical axis (SVA), C2–7 range of motion (ROM), CL in flexion, CL in extension, ROM of flexion (Flex ROM), and ROM of extension. The CL ratio (CLR) was defined as 100 × Flex ROM/ C2–7 ROM. ΔCL was defined as postoperative CL minus preoperative CL. Patients were classified into 2 groups: group K (kyphotic change group, ΔCL ≤ -10) and group C (control group, ΔCL > -10).
Results
The patient population comprised 94 men and 47 women (mean age, 70.9 ± 9.4 years), with 24 patients (17.0%) classified into group K. CL, C7 slope, and CLR were significantly higher in group K than in group C. The groups did not significantly differ in age, sex, C2–7 SVA, and C2–7 ROM. On multivariable analysis, the CLR was significantly associated with postoperative kyphotic changes. On receiver-operating characteristic curve analysis (area under the curve = 0.717, p < 0.001), the cutoff value for CLR was 68.9%, with sensitivity and specificity of 87.5% and 57.3%, respectively.
Conclusion
The CLR, reflecting the balance between flexion and extension mobility, was identified as a novel predictor for CL loss after laminoplasty, with a cutoff value of 68.9%.

Citations

Citations to this article as recorded by  Crossref logo
  • Impact of T1 Slope as a Predictor of Loss of Cervical Lordosis and Health-Related Quality of Life after Laminoplasty in Patients with Ossification of the Posterior Longitudinal Ligament : A Retrospective Cohort Study
    Ji-Ho Jung, Jong-Hoon Jeong, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
    Journal of Korean Neurosurgical Society.2026; 69(1): 124.     CrossRef
  • Analysis of Risk Factors for Cervical Kyphotic Deformity Despite Laminar Reconstruction in Cervical Intradural Tumor Surgery
    Hangeul Park, Woojin Kim, Jungbo Sim, Ho Sung Myeong, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim
    Operative Neurosurgery.2025;[Epub]     CrossRef
  • The effects of C2 instability on cervical curvature changes and clinical outcomes after sub-axial cervical expansive door-open laminoplasty
    Liang Ma, Yuntao Liu, Yanhai Xi, Changgui Shi, Xiangyu Meng
    Frontiers in Surgery.2025;[Epub]     CrossRef
  • Favorable cervical extension capacity preventing loss of cervical lordosis after laminoplasty due to spontaneous restoration of initial lordosis
    Xiaofei Cheng, Zhiqian Chen, Xiaojiang Sun, Changqing Zhao, Jie Zhao
    The Spine Journal.2024; 24(1): 94.     CrossRef
  • Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty
    Chengxin Liu, Wei Wang, Xiangyu Li, Bin Shi, Shibao Lu
    Spine.2024; 49(7): 492.     CrossRef
  • The preservation of cervical flexibility helps maintain cervical sagittal alignment after laminoplasty
    Chengxin Liu, Wei Wang, Xiangyu Li, Bin Shi, Shibao Lu
    The Spine Journal.2024; 24(11): 2058.     CrossRef
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    Chengxin Liu, Xiangyu Li, Wei Wang, Bin Shi, Shibao Lu
    BMC Surgery.2024;[Epub]     CrossRef
  • Greater cervical kyphosis during flexion increases the risk of kyphotic deformity after laminoplasty in patients with cervical spondylotic myelopathy
    Takashi Fujishiro, Takuya Obo, Yuki Yamamoto, Yoshitada Usami, Sachio Hayama, Yoshiharu Nakaya, Atsushi Nakano, Masashi Neo
    Journal of Clinical Neuroscience.2024; 125: 24.     CrossRef
  • Machine-learning-based models for the optimization of post-cervical spinal laminoplasty outpatient follow-up schedules
    Yechan Seo, Seoi Jeong, Siyoung Lee, Tae-Shin Kim, Jun-Hoe Kim, Chun Kee Chung, Chang-Hyun Lee, John M. Rhee, Hyoun-Joong Kong, Chi Heon Kim
    BMC Medical Informatics and Decision Making.2024;[Epub]     CrossRef
  • Predictors for cervical kyphotic deformity following laminoplasty: a systematic review and meta-analysis
    Samuel D. Pettersson, Paulina Skrzypkowska, Shan Ali, Tomasz Szmuda, Michał Krakowiak, Tadej Počivavšek, Fanny Sunesson, Justyna Fercho, Grzegorz Miękisiak
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  • Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty
    Chengxin Liu, Bin Shi, Wei Wang, Xiangyu Li, Shibao Lu
    BMC Musculoskeletal Disorders.2023;[Epub]     CrossRef
  • Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery
    Woon Tak Yuh, Minjung Kim, Yunhee Choi, Junghoon Han, Junhoe Kim, Taeshin Kim, Chun Kee Chung, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Moon Soo Park, Chi Heon Kim
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  • Commentary on “Surgical and Functional Outcomes of Expansive Open-Door Laminoplasty for Patients With Mild Kyphotic Cervical Alignment”
    Dongwuk Son
    Neurospine.2021; 18(4): 758.     CrossRef
  • 9,461 View
  • 220 Download
  • 13 Web of Science
  • 14 Crossref

Technical Note

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Dong-Ho Lee, Sehan Park, Woon Sang Lee, Chan Woong Byun, Sang Yun Seok, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee, Hyung Rae Lee
Neurospine 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241

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Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Neurospine. 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241
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Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis
Neurospine. 2020;17(3):640-647.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040482.241
Close
Cervical spondylotic myelopathy is surgically demanding when associated with rigid kyphosis. Posterior surgery cannot restore cervical lordosis, and adequate decompression is not possible with rigid kyphosis. Vertebral body sliding osteotomy (VBSO) is a safe and novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. It is safe in terms of dural tear, pseudarthrosis, and graft dislodgement, which are demonstrated at high rates in anterior cervical corpectomy and fusion. In addition, VBSO is a powerful method for restoring cervical lordosis through multilevel anterior cervical discectomy and fusion above and below the osteotomy level. It may be a feasible treatment option for patients with cervical spondylotic myelopathy and kyphotic deformity. This is a technical note and literature review that describes the procedures involved in VBSO.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluating MRI predictors for surgical outcomes in selective laminoplasty for OPLL-Induced cervical myelopathy: A comparative analysis of mKappa-line and mK-line
    Dong-Ho Lee, Hyung-Rae Lee, Sang Yun Seok, In Hee Kim, Dae Wi Cho, Jae-Hyuk Yang, Jae Hwan Cho, Chang Ju Hwang
    Journal of Orthopaedic Science.2026; 31(3): 561.     CrossRef
  • Dynamic K-Line Status and Surgical Outcomes in Multilevel Cervical OPLL: A Multicenter Comparative Study
    Jun Jae Shin, Sun Joon Yoo, Se Jun Park, Dong Kyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Chang Kyu Lee, Keung Nyun Kim, Tae Woo Kim, Yoon Ha
    Journal of Clinical Medicine.2026; 15(2): 520.     CrossRef
  • Evaluating the predictive value of K-line conversion in surgical outcomes for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL): laminectomy with fusion versus laminoplasty
    San Kim, Sehan Park, Chang Ju Hwang, Jae Hwan Cho, Dong-Ho Lee
    The Spine Journal.2025; 25(12): 2620.     CrossRef
  • Recent progress in surgical treatment of cervical spine myelopathy – A narrative review
    Jun Ouchida, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Shiro Imagama
    Journal of Clinical Orthopaedics and Trauma.2025; 68: 103074.     CrossRef
  • Strategic Use of Single-Level Vertebral Body Sliding Osteotomy Within a 360-Degree Fusion Construct for the Cervical Ossified Posterior Longitudinal Ligament
    Linhan Jasmine Ha, Sudhir Suggala, Adnan Shahid, Mehdi Khaleghi, Richard Menger
    Cureus.2025;[Epub]     CrossRef
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    Dong-Ho Lee, Hyung Rae Lee, Kiehyun Daniel Riew
    Asian Spine Journal.2024; 18(2): 274.     CrossRef
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    Christopher Wong, John F. Burke, Lee A. Tan
    Operative Neurosurgery.2023; 24(1): e48.     CrossRef
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    Min Woo Kim, Chang-Nam Kang, Sung Hoon Choi
    Asian Spine Journal.2023; 17(1): 213.     CrossRef
  • Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy
    Yong-Ho Lee, Mahmoud Abdou, Ji-Won Kwon, Kyung-Soo Suk, Seong-Hwan Moon, You-Gun Won, Tae-Jin Lee, Byung-Ho Lee
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  • Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Outcomes at Minimum Five years Follow-up
    Dong-Ho Lee, Sehan Park, Choon Sung Lee, Chang Ju Hwang, Jae Hwan Cho, Sung Tan Cho
    Spine.2023; 48(9): 600.     CrossRef
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    Sehan Park, Dong-Ho Lee, Choon Sung Lee, Chang-Ju Hwang, Jae Jun Yang, Jae Hwan Cho
    Asian Spine Journal.2023; 17(3): 582.     CrossRef
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    Spine.2023; 48(21): 1526.     CrossRef
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    Hyung Rae Lee, Dong-Ho Lee, Sang Yun Seok, Sehan Park, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee
    Neurospine.2022; 19(2): 412.     CrossRef
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    Dong-Ho Lee, Sehan Park, Chul Gie Hong, Kun-Bo Park, Jae Hwan Cho, Chang Ju Hwang, Jae Jun Yang, Choon Sung Lee
    The Spine Journal.2021; 21(7): 1089.     CrossRef
  • Laminectomy with instrumented fusion vs. laminoplasty in the surgical treatment of cervical ossification of the posterior longitudinal ligament: A multicenter retrospective study
    Jong Joo Lee, Hyung Cheol Kim, Hyeong Seok Jeon, Seong Bae An, Tae Woo Kim, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Hyun Chul Shin, Narihito Nagoshi, Kota Watanabe, Da He, Daniel J. Hoh, K. Daniel Riew, Jun Jae Shin, Yoon Ha
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  • 317 Download
  • 17 Web of Science
  • 16 Crossref

Review Article

Cervical Sagittal Alignment: Literature Review and Future Directions
Sang Hun Lee, Seung-Jae Hyun, Amit Jain
Neurospine 2020;17(3):478-496.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040392.196

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Cervical Sagittal Alignment: Literature Review and Future Directions
Neurospine. 2020;17(3):478-496.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040392.196
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Cervical Sagittal Alignment: Literature Review and Future Directions
Neurospine. 2020;17(3):478-496.   Published online September 30, 2020
DOI: https://doi.org/10.14245/ns.2040392.196
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Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the ‘5W1H’ framework; “WHO” are related?, “WHY” important?, “WHAT” to evaluate and “WHAT” is normal?, “HOW” to evaluate?, “WHEN” to apply sagittal balance?, and “WHERE” to go in the future?

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  • Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom
    Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim
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  • Cervical Alignment Analysis Comparing Two-Level Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion with Anterior Plate Fixation
    Adewale A. Bakare, John Paul G. Kolcun, Ali Z. Piracha, Jonah R. Moss, Ryan Khanna, John E. O’Toole, Harel Deutsch, Vincent C. Traynelis, Richard G. Fessler
    World Neurosurgery.2022; 165: e597.     CrossRef
  • Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty?
    Sibo Lin, Taotao Lin, Zhengru Wu, Gang Chen, Zhitao Shangguan, Zhenyu Wang, Wenge Liu
    The Spine Journal.2022; 22(12): 1953.     CrossRef
  • Validity and reliability of a novel iPhone method to rapidly measure cervical sagittal parameters
    Jie Zhang, Chunyang Zhang, Weiyang Zhong, Zenghui Zhao, Fei Han, Zhenghan Han, Hang Zhang, Tianji Huang, Xiaoji Luo
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  • Changes in T1 slope and cervical sagittal vertical axis correlate to improved neurological function recovery after cervical laminoplasty
    Dong-Fan Wang, Xiang-Yu Li, Chao Kong, Cheng-Xin Liu, Bin Shi, Shi-Bao Lu
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  • Total disc replacement alters the biomechanics of cervical spine based on sagittal cervical alignment
    Muzammil Mumtaz, Justin Mendoza, Sudharshan Tripathi, Amey Kelkar, Norihiro Nishida, Ashish Sahai, Vijay K. Goel
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    Wenhao Wang, Yixue Huang, Zhikai Wu, Xiayu Hu, Pan Xiang, Hao Liu, Huilin Yang
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma
    Jungmyung Koo, SungHwan Hwang, Sang Hoon Yoon, Hyung Jin Shin, Byung-Kyu Cho
    Korean Journal of Neurotrauma.2022; 18(2): 254.     CrossRef
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    Hyung Rae Lee, Dong-Ho Lee, Sang Yun Seok, Woon Sang Lee, Minsoo Kim, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee
    Journal of Neurosurgery: Spine.2022; : 1.     CrossRef
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    Justin W. Vickery, Emil E. Varas, Amir M. Abtahi
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    D. A. Glukhov, V. I. Zorin, Ya. A. Maltseva, A. Yu. Mushkin
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    Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim
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    Hyung Cheol Kim, Sung Han Oh, Jae Keun Oh, Yoon Ha
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    Journal of Korean Neurosurgical Society.2021; 64(5): 776.     CrossRef
  • The state of the sagittal balance of the injured cervical spine depending on the nature of the damage to the subaxial level
    O.S. Nekhlopochyn, V.V. Verbov
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Original Articles

Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience
Jiin Kang, Naobumi Hosogane, Christopher Ames, Frank Schwab, Robert Hart, Douglas Burton, Christopher Shaffrey, Justin S. Smith, Shay Bess, Virginie Lafage, Kyu-Jung Cho, Yoon Ha, for the International Spine Study Group and Asian Pacific Spine Study Group
Neurospine 2018;15(4):353-361.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836086.043

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Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience
Neurospine. 2018;15(4):353-361.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836086.043
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Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience
Neurospine. 2018;15(4):353-361.   Published online August 29, 2018
DOI: https://doi.org/10.14245/ns.1836086.043
Close
Objective
This study is aimed to investigate whether surgical strategies for adult spinal deformity (ASD) treatment differed among Korean physicians.
Methods
This study is retrospective questionnaire-based study. ASD is challenging to manage, with a broad range of clinical and radiological presentations. To investigate possible nationality- or ethnicity-related differences in the surgical strategies adopted for ASD treatment, the International Spine Study Group surveyed physicians’ responses to 16 cases of ASD. We reviewed the answers to this survey from Korean physicians. Korean orthopedic surgeons (OS) and neurosurgeons (NS) received a questionnaire containing 16 cases and response forms via email. After reviewing the cases, physicians were asked to indicate whether they would treat each case with decompression or fusion. If fusion was chosen, physicians were also asked to indicate whether they would perform 3-column osteotomy. Retrospective chi-square analyses were performed to investigate whether the answers to each question differed according to training specialty or amount of surgical experience.
Results
Twenty-nine physicians responded to our survey, of whom 12 were OS and 17 were NS. In addition, 18 (62.1%) had more than 10 years of experience in ASD correction and were assigned to the M10 group, while 11 (37.9%) had less than 10 years of experience and were assigned to the L10 group. We found that for all cases, the surgical strategies favored did not significantly differ between OS and NS or between the M10 and L10 groups. However, for both fusion surgery and 3-column osteotomy, opinions were divided regarding the necessity of the procedures in 4 of the 16 cases.
Conclusion
The surgical strategies favored by physicians were similar for most cases regardless of their training specialty or experience. This suggests that these factors do not affect the surgical strategies selected for ASD treatment, with patient clinical and radiological characteristics having greater importance.

Citations

Citations to this article as recorded by  Crossref logo
  • Specialty Bias When Comparing Orthopaedic and Neurosurgery Trained Spine Surgeons: A Systematic Review and Bibliometric Analysis
    Daniel Farivar, Sang D. Kim, Alexander Tuchman, Kira F. Skaggs, Ryan A. Finkel, Paal K. Nilssen, David L. Skaggs
    Journal of the American Academy of Orthopaedic Surgeons.2026; 34(6): e918.     CrossRef
  • Association of frailty with regional sagittal spinal alignment in the elderly
    Yun Gi Hong, Hyung-Cheol Kim, Hyeongseok Jeon, Seong Bae An, Ji Yeon Lee, Jong Joo Lee, Kwang Joon Kim, Chang Oh Kim, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Tae Woo Kim, Yoon Ha
    Journal of Clinical Neuroscience.2022; 96: 172.     CrossRef
  • Systematic Review of Reciprocal Changes after Spinal Reconstruction Surgery : Do Not Miss the Forest for the Trees
    Chang-Wook Kim, Seung-Jae Hyun, Ki-Jeong Kim
    Journal of Korean Neurosurgical Society.2021; 64(6): 843.     CrossRef
  • Posterior-only versus combined anterior-posterior fusion in Scheuermann disease: a systematic review and meta-analysis
    Chang-Hyun Lee, Young II Won, Young San Ko, Seung Heon Yang, Chi Heon Kim, Sung Bae Park, Chun Kee Chung
    Journal of Neurosurgery: Spine.2021; 34(4): 608.     CrossRef
  • Association of Frailty and Self-Care Activity With Sagittal Spinopelvic Alignment in the Elderly
    Tae Woo Kim, Jae Keun Oh, Ji Yeon Lee, Samuel K. Cho, Seong Bae An, Hyeong Seok Jeon, Hyung Cheol Kim, Kwang Joon Kim, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Chang Oh Kim, Yoon Ha
    World Neurosurgery.2020; 138: e759.     CrossRef
  • Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders
    Jong Joo Lee, Sung Han Oh, Yeong Ha Jeong, Sang Man Park, Hyeong Seok Jeon, Hyung-Cheol Kim, Seong Bae An, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Jun Jae Shin, Yoon Ha
    Neurospine.2020; 17(3): 513.     CrossRef
  • Kyphectomy and interbody fixation using lag screws in a child with myelomeningocele kyphosis: a technical case report
    Seong-Hyun Wui, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun Jib Kim
    Child's Nervous System.2019; 35(8): 1407.     CrossRef
  • From the Champion to the Team: New Treatment Paradigms in Contemporary Neurosurgery
    Teresa Somma, Tamara Ius, Francesco Certo, Laura Santi, Michelangelo de Angelis, Flavia Dones, Marco Cenzato, Miran Skrap, Paolo Cappabianca
    World Neurosurgery.2019; 131: 141.     CrossRef
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  • 182 Download
  • 9 Web of Science
  • 8 Crossref
A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis
Li-Yu Fay, Chih-Chang Chang, Hsuan-Kan Chang, Tsung-Hsi Tu, Tzu-Yun Tsai, Ching-Lan Wu, Wen-Cheng Huang, Jau-Ching Wu, Henrich Cheng
Neurospine 2018;15(3):231-241.   Published online August 22, 2018
DOI: https://doi.org/10.14245/ns.1836108.054

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A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis
Neurospine. 2018;15(3):231-241.   Published online August 22, 2018
DOI: https://doi.org/10.14245/ns.1836108.054
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A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis
Neurospine. 2018;15(3):231-241.   Published online August 22, 2018
DOI: https://doi.org/10.14245/ns.1836108.054
Close
Objective
The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis.
Methods
This retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain.
Results
Thirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p < 0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p = 0.116). There were no significant differences in lumbar alignment between the 2 groups.
Conclusion
During a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

Citations

Citations to this article as recorded by  Crossref logo
  • The Effect of Osteopenia and Osteoporosis on Screw Loosening in MIS-TLIF and Dynamic Stabilization
    Hsuan-Kan Chang, Chih-Chang Chang, Yu-Wen Cheng, Ching-Lan Wu, Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang
    Global Spine Journal.2025; 15(4): 2209.     CrossRef
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    Shih-Hao Chen, Shang-Chih Lin, Chi-Ruei Li, Zheng-Cheng Zhong, Chih-Ming Kao, Mao-Shih Lin, Hsi-Kai Tsou
    Journal of Clinical Medicine.2025; 14(22): 8087.     CrossRef
  • A Retrospective Observational Study to Evaluate Adjacent Segmental Degenerative Change with the Dynesys-Transition-Optima Instrumentation System
    Chi-Ruei Li, Shih-Hao Chen, Wen-Hsien Chen, Hsi-Kai Tsou, Chung-Yuh Tzeng, Tse-Yu Chen, Mao-Shih Lin
    Journal of Clinical Medicine.2024; 13(2): 582.     CrossRef
  • A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery
    Wei Fan, Song Yang, Jie Chen, Li-Xin Guo, Ming Zhang
    Neurospine.2024; 21(1): 244.     CrossRef
  • Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients
    Chih-Chang Chang, Hsuan-Kan Chang, Chin-Chu Ko, Ching-Lan Wu, Yi-Hsuan Kuo, Tsung-Hsi Tu, Wen-Cheng Huang, Jau-Ching Wu
    Neurospine.2023; 20(1): 308.     CrossRef
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    Jianbin Guan, Tao Liu, Xing Yu, Wenhao Li, Ningning Feng, Guozheng Jiang, He Zhao, Yongdong Yang
    BioMedical Engineering OnLine.2023;[Epub]     CrossRef
  • Cortical Bone Trajectory-Based Dynamic Stabilization
    Yi-Hsuan Kuo, Chao-Hung Kuo, Hsuan-Kan Chang, Chin-Chu Ko, Tsung-Hsi Tu, Chih-Chang Chang, Henrich Cheng, Jiing-Feng Lirng, Wen-Cheng Huang, Jau-Ching Wu
    World Neurosurgery.2022; 159: e416.     CrossRef
  • Efficacy of the Dynesys Hybrid Surgery for Patients with Multi-Segmental Lumbar Spinal Stenosis
    Xiao Xiao, Gaoyang Chen, Song Wang, Junliang Liu, Erhu Lin, Ke Chen, Yucheng Xiang, Ke Zhan, Congcong Liu, Zhengbin Yuan, Minjie Yang, Shuyuan Zhong, Wanxin Zhen, Dazhi Yang, Songlin Peng
    Frontiers in Surgery.2022;[Epub]     CrossRef
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    Chih-Kun Hsiao, Yi-Jung Tsai, Cheng-Yo Yen, Yi-Chen Li, Hao-Yuan Hsiao, Yuan-Kun Tu
    Bioengineering.2022; 10(1): 31.     CrossRef
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    Hyun-Jae Cho, Young San Ko, Young Il Won, Chang-Hyun Lee, Seung Heon Yang, Chi Heon Kim, Chun Kee Chung
    Clinical Spine Surgery.2021; 34(7): 260.     CrossRef
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    Hsuan-Kan Chang, Jason Ku, Johnson Ku, Yi-Hsuan Kuo, Chih-Chang Chang, Ching-Lan Wu, Jiing-Feng Lirng, Jau-Ching Wu, Wen-Cheng Huang, Henrich Cheng, Shih-Ming Hsu
    Scientific Reports.2021;[Epub]     CrossRef
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    Liehua Liu, Lei Luo, Chen Zhao, Qiang Zhou, Sidong Yang
    Pain Research and Management.2021; 2021: 1.     CrossRef
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    Cem DEMİREL, Dursun TÜRKÖZ, Tuncay YİLMAZ
    Archives of Clinical and Experimental Medicine.2021; 6(3): 153.     CrossRef
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    Chih-Chang Chang, Hsuan-Kan Chang, Jau-Ching Wu, Tsung-Hsi Tu, Henrich Cheng, Wen-Cheng Huang
    World Neurosurgery.2020; 139: e489.     CrossRef
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    Hongbo Wang, Jun Peng, Qingshen Zeng, Yanchun Zhong, Chunlin Xiao, Yongjun Ye, Weimin Huang, Wuyang Liu, Jiaquan Luo
    Medicine.2020; 99(21): e19784.     CrossRef
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    Sanghyun Han, Bumsoo Park, Jeong-Wook Lim, Jin-Young Youm, Seoung-Won Choi, Dae Hwan Kim, Dong Ki Ahn
    Journal of Korean Neurosurgical Society.2020; 63(6): 673.     CrossRef
  • Commentary: Low-Grade Infection and Implant Failure Following Spinal Instrumentation: A Prospective Comparative Study
    Hsuan-Kan Chang, Wen-Cheng Huang, Jau-Ching Wu
    Neurosurgery.2020; 87(5): E541.     CrossRef
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    Yi-Hsuan Kuo, Chao-Hung Kuo, Hsuan-Kan Chang, Tsung-Hsi Tu, Li-Yu Fay, Chih-Chang Chang, Henrich Cheng, Ching-Lan Wu, Jiing-Feng Lirng, Jau-Ching Wu, Wen-Cheng Huang
    Journal of Neurosurgery: Spine.2020; 33(3): 398.     CrossRef
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Clinical Article

The Effect of Different Pillow Heights on the Parameters of Cervicothoracic Spine Segments
Hyung Cheol Kim, Hyo Sub Jun, Ji Hee Kim, Jun Hyong Ahn, In Bok Chang, Joon Ho Song, Jae Keun Oh
Korean J Spine 2015;12(3):135-138.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.135

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The Effect of Different Pillow Heights on the Parameters of Cervicothoracic Spine Segments
Korean J Spine. 2015;12(3):135-138.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.135
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The Effect of Different Pillow Heights on the Parameters of Cervicothoracic Spine Segments
Korean J Spine. 2015;12(3):135-138.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.135
Close
Objective

To investigate the effect of different pillow heights on the slope of the cervicothoracic spine segments.

Methods

A prospective analysis of data from 16 asymptomatic adults (aged 20 to 30 years) was carried out. Exclusion criteria were history of injury or accident to the cervicothoracic spine, cervicothoracic spine surgery, or treatment for neck symptoms. We used three different pillow heights: flat (0 cm), 10-cm, and 20-cm pillows. Cervical sagittal parameters, measured with radiography, included; C2-7 Cobb's angle, T1 slope (T1S), thoracic inlet angle (TIA), and neck tilt (NT). Statistical analyses were performed using Spearman correlation coefficients.

Results

As the height of the pillow increased, the T1S & C2-7 Cobb's angle increased while the NT values tended to decrease. The TIA values, however, remained constant. Additionally, there was a statistically significant sex difference in T1S with the 0-cm pillow (p=0.01), and in NT with the 20-cm pillow (p=0.01).

Conclusion

From the data obtained in this study, we recommend that the most suitable pillow height is 10 cm, considering the normal cervical lordosis.

Citations

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    Samaneh Daryushi, Teimour Allahyari, Zanyar Karimi
    The Open Public Health Journal.2025;[Epub]     CrossRef
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    Swarup Ghosh, Manu Goyal, Kanu Goyal
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    S. Ghosh, M. Goyal, K. Goyal
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    Eun-mi Kim, Min-gi Park, Eun-joung Yu, Dongyeop Lee, Ji-Heon Hong, Jae-Ho Yu, Jin-Seop Kim, Yeon Gyo Nam, Seong-Gil Kim
    Journal of The Korean Society of Physical Medicine.2024; 19(1): 53.     CrossRef
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    Kyeong-Ah Moon, Ji-Hyun Kim, Ye Jin Kim, Joo-Hee Park, Hye-Seon Jeon
    Physical Therapy Korea.2024; 31(1): 8.     CrossRef
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    Mutsumi Takahashi, Yogetsu Bando, Takuya Fukui
    Advances in Physical Education.2024; 14(04): 204.     CrossRef
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    Nonoka FUJIWARA, Satoshi MURAKI
    The Japanese Journal of Ergonomics.2023; 59(1): 29.     CrossRef
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    Ceyhun Türkmen, Serdar Yılmaz Esen, Zafer Erden, Tülin Düger
    Applied Sciences.2023; 13(6): 3865.     CrossRef
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    Bilal Al Barim, Michael Müther, Stephanie Schipmann, Walter Stummer, Michael Schwake
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    Ahmed Radwan, Nicholas Ashton, Trever Gates, Austin Kilmer, Michael VanFleet
    European Journal of Integrative Medicine.2021; 42: 101269.     CrossRef
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    Johnson C.Y. Pang, Sharon M.H. Tsang, Allan C.L. Fu
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    Jia-Xing Lei, Peng-Fei Yang, Ai-Ling Yang, Yan-Feng Gong, Peng Shang, Xi-Chen Yuan
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    Min-hyeok Choi, Jin-Hwa Jung, Jong-Hoon Moon, Jin-won Yoo, Suk-Chan Hahm, Hwi-young Cho
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