Adult Cervical Deformity Review Outlines Alignment Targets and Surgical Risks

A review in The Journal of Bone and Joint Surgery addresses evaluation, classification, and surgical decision-making for adult cervical deformity. It identifies standing full-spine radiographs as mandatory for assessment and emphasizes integrating deformity flexibility, neurological status, global alignment, bone quality, and patient-specific factors into operative planning.

Key alignment targets are cervical sagittal vertical axis ≤40 mm, T1 slope minus cervical lordosis <15°, and chin-brow vertical angle between −10° and +10° relative to true vertical. Achieving these thresholds is independently associated with better patient-reported outcomes. The Kim–International Spine Study Group classification distinguishes four patterns—flat neck, focal, cervicothoracic, and coronal or complex—using standing and dynamic extension radiographs. The review reports better interrater and intrarater reliability than earlier descriptive systems, although its direct effect on surgical outcomes requires prospective validation.

Surgical planning also considers the intended lower instrumented vertebra and whether ankylosis necessitates osteotomy. Overall complication rates exceed 50% in cited prospective multicenter data, despite clinically meaningful improvements in pain and health-related quality of life at 1 year among appropriately selected patients. The review emphasizes neuromonitoring, tranexamic acid, staged approaches, and frailty-based selection for risk mitigation. The supplied extract provides no sample sizes or effect estimates for these outcomes; alignment associations should not be interpreted as proof of causal benefit.