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Related Experiment Video

Updated: Feb 7, 2026

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Cervical sagittal alignment as a predictor of adjacent-level ossification development.

Wei Liu1, Yuluo Rong1, Jian Chen1

  • 1Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China, fanjingol@126.com, caiwhspine@sina.com.

Journal of Pain Research
|July 28, 2018
PubMed
Summary

Maintaining a lordotic cervical alignment reduces the risk of adjacent-level ossification development (ALOD) after anterior cervical discectomy fusion. This alignment also correlates with better clinical outcomes and patient satisfaction.

Keywords:
adjacent-level ossification developmentcervical sagittal alignmentclinical outcomesstand-alone anchored cage

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Degenerative spine disease

Background:

  • Anterior cervical plating systems are standard for cervical disc herniation.
  • Plate proximity (<5 mm) to adjacent disc space is a risk factor for adjacent-level ossification development (ALOD).
  • The influence of cervical sagittal alignment on ALOD remains unclear.

Purpose of the Study:

  • To investigate the role of cervical sagittal alignment in ALOD after anterior cervical discectomy fusion (ACDF).
  • To examine the relationship between cervical sagittal alignment and clinical outcomes in ACDF patients.

Main Methods:

  • Retrospective analysis of 118 adult patients undergoing ACDF with a polyetheretherketone cage.
  • Comparison of cervical sagittal parameters (Cobb angle, cervical tilt, T1 slope) between patients with and without ALOD.
  • Evaluation of clinical outcomes using Visual Analog Scale, Japanese Orthopedic Association (JOA) score, and Neck Disability Index (NDI) score.

Main Results:

  • Cervical sagittal parameters including Cobb angle, cervical tilt (CT), and T1 slope (T1S) differed significantly between groups with and without ALOD.
  • Patients without ALOD showed significantly better postoperative clinical outcomes (JOA, NDI) at 24 months.
  • T1 slope demonstrated significant correlations with both cervical sagittal alignment parameters and clinical outcomes (JOA, NDI).

Conclusions:

  • A lordotic cervical sagittal alignment is associated with a reduced risk of ALOD after ACDF.
  • Maintaining proper cervical lordosis positively impacts clinical outcomes following ACDF surgery.