Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity.


Study design

Multicenter, prospective, consecutive case series.


To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities.

Summary of background data

Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity.


Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°).


A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46).


Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.

Level of evidence






Published Version (Please cite this version)


Publication Info

Smith, Justin S, Virginie Lafage, Frank J Schwab, Christopher I Shaffrey, Themistocles Protopsaltis, Eric Klineberg, Munish Gupta, Justin K Scheer, et al. (2014). Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine, 39(17). pp. E1001–E1009. 10.1097/brs.0000000000000432 Retrieved from

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Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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