• Jessica A Tang, Justin K Scheer, Justin S Smith, Vedat Deviren, Shay Bess, Robert A Hart, Virginie Lafage, Christopher I Shaffrey, Frank Schwab, Christopher P Ames, and ISSG.
• *Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; ‡University of California, San Diego, School of Medicine, San Diego, California; §Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California; ¶Rocky Mountain Scoliosis and Spine Center, Denver, Colorado; ‖Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, Oregon; #Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; **Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
• Neurosurgery. 2015 Mar 1; 76 Suppl 1: S14-21; discussion S21.

BackgroundPositive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.ObjectiveTo evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.MethodsFrom 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.ResultsBoth C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r =-0.43, P< .001 and r =-0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.ConclusionOur findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

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