[Challenges and critical issues in the management of cervical spine deformities]

Cervical spine deformity (CSD) represent some of the most formidable challenges in spinal surgery, characterized by complex etiologies, high disability rates, and significant surgical risks. Recent advancements in the understanding of the pathophysiology and management strategies for CSD have facilitated a paradigm shift from traditional, experience-based approaches to precision medicine guided by multidimensional imaging data and comprehensive sagittal alignment assessment. Imaging-based classification systems have optimized the evaluation and classification of deformities by incorporating dynamic imaging and global sagittal balance parameters, thereby providing a reliable foundation for individualized treatment plans. Furthermore, the importance of comprehensive functional assessment has gained prominence, particularly with the use of the frailty index, which offers new insights for risk prediction and optimizing surgical decision-making. In terms of surgical strategies, the use of high-grade osteotomies has improved correction outcomes for complex deformities, yet also demands more stringent management of associated complications. The management of CSD is evolving towards greater precision and individualization, aiming to enhance outcomes by integrating multimodal imaging, functional assessments, and advanced surgical techniques-ultimately leading to better clinical prognosis and quality of life for patients.