The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery.

Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes. Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2-C7 Cobb \u3e10°, cervical lordosis (CL) \u3e10°, C2-C7 sagittal vertical axis (cSVA) \u3e4 cm, and chin-brow vertical angle \u3e 25°. Patients were evaluated for level and type of cervical osteotomy. Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m Conclusions: CD patients undergoing osteotomies in the cervical and upper thoracic spine experienced improvement in TS--CL and C2 slope. In the upper thoracic spine, multiple minor osteotomies achieved similar alignment changes to major osteotomies at a single level, while a major osteotomy focused at T2 had the greatest overall impact in cervicothoracic and global alignment in CD patients