Cervical sagittal balance after AIS instrumentation

  • Ali Asma Nemours Alfred I. duPont Hospital, Department of Orthopedic Surgery Wilmington, Delaware
  • Haluk Berk Department of Orthopedic Surgery,Dokuz Eylul University,Izmir,Turkey
Keywords: Scoliosis, cervical sagittal balance, spinal instrumentation


Cervical sagittal balance is one of the trending topics in the literatures. More than 60 articles were published on this hot topic. The harmonious relationship between spinal curves and kyphotic deterioration proximal to instrumentation made the researchers’ main intentions. Most authors investigate the changes in cervical sagittal curves after AIS instrumentation and look for any correlation between the sagittal parameter that could hint at potential changes after instrumentation. Some authors look into the upper instrumentation level effect on cervical alignment others searched for coronal plane deformities effect on the sagittal plane. Prospective studies will be more convincing since retrospective studies show the opposite results. A meta-analysis of future prospective studies will clarify the confusion on upper instrumentation level effect on CSB, implant choice of instrumentation, PJK reasons, correlation with global spine balance, and finally, relationship with whole-body alignment. Correction of thoracic hypokyposis, especially proximal thoracic, could stimulate cervical lordotic changes over time. Flattening of the entire spine either by surgery or bracing ends up with cervical kyphosis. In this updated historical review of cervical sagittal balance after AIS instrumentation, we want to report the most current and organized knowledge of this exciting area of the spine studies. To make it more systematic, we subdivide primary theme into six main sections to answer all the potential questions of the readers. While giving essential information about cervical sagittal balance, we also delve into details to clarify this very confusing area.


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