Objectives:To develop a cervical kyphosis frailty index (CK-FI) and explore its clinical value in identifying high-risk patients undergoing cervical kyphosis correction surgery.Methods:In this retrospective case series, clinical data from 53 patients who underwent cervical kyphosis correction at the Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, between January 2019 and December 2023 were analyzed. All patients had a minimum follow-up of 12 months. There were 27 males and 26 females, with an age of (53.4±14.5) years (range: 15 to 83 years). Demographic data, comorbidities, laboratory results, radiographic parameters, and functional assessments were collected. Fifteen key indicators related to physiological reserve and stress tolerance in cervical kyphosis patients were identified via Pearson correlation analysis to establish the CK-FI. Differences in demographic characteristics, clinical outcomes, postoperative complications, and length of hospital stay among CK-FI subgroups were analyzed using independent sample t-tests, one-way ANOVA,Wilcoxon signed-rank tests, Mann-Whitney U tests, Kruskal-Wallis tests, and chi-square or Fisher′s exact tests. Binary logistic regression was employed to determine independent risk factors for postoperative complications. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of CK-FI for postoperative complications. Results:Based on CK-FI scores, patients were classified into non-frail (CK-FI<0.3), frail (0.3≤CK-FI≤0.5), and severely frail (CK-FI>0.5) groups. The 30-day postoperative complication rate was 26.4% (14/53). Both univariate and multivariate analyses indicated that frailty ( OR=6.892, 95% CI: 1.239 to 38.353, P=0.028) and severe frailty ( OR=10.313, 95% CI: 1.877 to 56.659, P=0.007) were independent risk factors for postoperative complications. ROC analysis revealed that CK-FI had an area under the curve of 0.777 (95% CI: 0.637 to 0.917, P=0.001), with a specificity of 70.3% and a sensitivity of 81.3% in predicting postoperative complications. Conclusions:The CK-FI serves as a valuable tool for early detection of high-risk patients with cervical kyphosis, aiding in individualized perioperative management, optimizing preoperative preparation, reducing postoperative complications, and ultimately improving patient outcomes.

The etiology of cervical and cervicothoracic deformities is complex, often resulting in spinal cord compression and neurological dysfunction, seriously affecting patients′ quality of life and life expectancy. This article focuses on the diagnosis, treatment, and clinical research of complex cervical and cervicothoracic deformities. In terms of surgical treatment, decisions are individualized based on the patient′s condition, with techniques such as anterior-posterior combined approach, crossing the cervicothoracic junction for fusion and fixation, and three-column osteotomy being used when necessary. Additionally, robot-assisted surgery and intraoperative navigation technologies are gradually being implemented. The enhanced recovery after surgery concept aids in optimizing postoperative rehabilitation and reducing the incidence of complications. In the future, artificial intelligence and innovative internal fixation devices are expected to further drive the personalization and precision of treatment. Overall, despite significant progress in the clinical management of cervical and cervicothoracic deformities, challenges remain in optimizing postoperative rehabilitation, reducing complications, and improving long-term quality of life in this field.

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.

Objectives:To develop a cervical kyphosis frailty index (CK-FI) and explore its clinical value in identifying high-risk patients undergoing cervical kyphosis correction surgery.Methods:In this retrospective case series, clinical data from 53 patients who underwent cervical kyphosis correction at the Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, between January 2019 and December 2023 were analyzed. All patients had a minimum follow-up of 12 months. There were 27 males and 26 females, with an age of (53.4±14.5) years (range: 15 to 83 years). Demographic data, comorbidities, laboratory results, radiographic parameters, and functional assessments were collected. Fifteen key indicators related to physiological reserve and stress tolerance in cervical kyphosis patients were identified via Pearson correlation analysis to establish the CK-FI. Differences in demographic characteristics, clinical outcomes, postoperative complications, and length of hospital stay among CK-FI subgroups were analyzed using independent sample t-tests, one-way ANOVA,Wilcoxon signed-rank tests, Mann-Whitney U tests, Kruskal-Wallis tests, and chi-square or Fisher′s exact tests. Binary logistic regression was employed to determine independent risk factors for postoperative complications. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of CK-FI for postoperative complications. Results:Based on CK-FI scores, patients were classified into non-frail (CK-FI<0.3), frail (0.3≤CK-FI≤0.5), and severely frail (CK-FI>0.5) groups. The 30-day postoperative complication rate was 26.4% (14/53). Both univariate and multivariate analyses indicated that frailty ( OR=6.892, 95% CI: 1.239 to 38.353, P=0.028) and severe frailty ( OR=10.313, 95% CI: 1.877 to 56.659, P=0.007) were independent risk factors for postoperative complications. ROC analysis revealed that CK-FI had an area under the curve of 0.777 (95% CI: 0.637 to 0.917, P=0.001), with a specificity of 70.3% and a sensitivity of 81.3% in predicting postoperative complications. Conclusions:The CK-FI serves as a valuable tool for early detection of high-risk patients with cervical kyphosis, aiding in individualized perioperative management, optimizing preoperative preparation, reducing postoperative complications, and ultimately improving patient outcomes.

The etiology of cervical and cervicothoracic deformities is complex, often resulting in spinal cord compression and neurological dysfunction, seriously affecting patients′ quality of life and life expectancy. This article focuses on the diagnosis, treatment, and clinical research of complex cervical and cervicothoracic deformities. In terms of surgical treatment, decisions are individualized based on the patient′s condition, with techniques such as anterior-posterior combined approach, crossing the cervicothoracic junction for fusion and fixation, and three-column osteotomy being used when necessary. Additionally, robot-assisted surgery and intraoperative navigation technologies are gradually being implemented. The enhanced recovery after surgery concept aids in optimizing postoperative rehabilitation and reducing the incidence of complications. In the future, artificial intelligence and innovative internal fixation devices are expected to further drive the personalization and precision of treatment. Overall, despite significant progress in the clinical management of cervical and cervicothoracic deformities, challenges remain in optimizing postoperative rehabilitation, reducing complications, and improving long-term quality of life in this field.

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.

Objective:To explore the correlation between cervical curve and ossification of ligaments in cranio-cervical junction and cervical spine in patients with cervical degenerative diseases.Methods:A retrospective study was conducted among 458 patients with cervical degenerative disease who underwent cervical spine X-ray and CT examinations at the Orthopedics Department of Beijing Tiantan Hospital, Capital Medical University between January 2016 and July 2020. There were 265 males and 193 females, with an average age of 57.02±10.41 years (range, 22-87 years). Patients were divided into 5 types (lordosis, straight, S-type degenerative kyphosis, R-type degenerative kyphosis and C-type degenerative kyphosis). Cervical lordosis was defined as C 2-C 7 curve <-4°, cervical kyphosis was defined as >4°, cervical straight was defined as -4° to 4°. C 2-C 7 curve, C 0-C 2 curve were measured respectively, and correlations among these imaging parameters were analyzed. CT images were used to assess the presence of ossification of ligaments in cranio-cervical and cervical spine, including ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH), as well as capped dens sign (CDS), and correlations between these cervical curve and presence of ossification of ligaments were analyzed. The different grades were based on the length of the ossification of interest with respect to the distance from the posterosuperior rim of the anterior arch of the atlas to the inferior margin of the foramen magnum on mid-sagittal cervical spine CT images, Grade 3 CDS was determined when the length was more than two-thirds. Results:There were 245 patients with cervical lordosis, 114 patients with straight, 53 patients with S-type degenerative cervical kyphosis, 36 patients with R-type degenerative cervical kyphosis and 10 patients with C-type degenerative cervical kyphosis. C 0-C 2 curve showed a negative correlation with C 2-C 7 curve in all enrolled patients ( r=-0.45, P<0.001) and R-type degenerative kyphosis group ( r=-0.58, P<0.001); C 0-C 2 curve showed no correlation with C 2-C 7 curve in lordosis ( r=-0.10, P=0.124), straight ( r=-0.11, P=0.233), S-type degenerative kyphosis ( r=-0.01, P=0.943) or C-type degenerative kyphosis groups ( r=0.03, P=0.946). CDS was detected in 38.4% (176/458) of patients, and Grade 3 was detected in 17.9% (82/458) of patients. The prevalence of CDS was correlated with R-type degenerative cervical kyphosis ( r=0.10, P=0.030). Cervical kyphosis, S-type degenerative kyphosis, C-type degenerative kyphosis, C 2-C 7 curve and C 0-C 2 curve showed no correlation with ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH) or different grades CDS ( P>0.05). Conclusion:R-type degenerative cervical kyphosis are more likely to correlate with the cranio-cervical curve and CDS, which is an ossification of ligament in cranio-cervical junction.

Objective:To identify the potential impact of cervical spine kyphosis on muscle parameters, the correlation between life quality score and muscle parameters, the correlation between cervical sagittal parameters and muscle parameters.Methods:From September 30, 2019 to September 30, 2020, 30 patients diagnosed with cervical kyphosis and 34 volunteers with normal cervical curvature were enrolled in this case control study. Kyphosis group and control group were matched with sex (χ 2=0.23, P=0.75), age ( t=0.13, P=0.73), BMI ( t=0.26, P=0.20) and neck pain duration time ( t=4.67, P=0.68). Visual analogue scale (VAS) and the neck disability index (NDI) were applied. Cervical sagittal parameters and cervical range of motion (ROM) were measured on lateral radiographs of cervical spine, which included C 2-C 7 lordosis (CL), cervical sagittal vertical axis (C 2-C 7 SVA), T 1-slope (T 1S) and spinal canal angle (SCA). To evaluate muscle functions, Co-contraction ratio (CCR) was measured by surface electromyography (SEMG). Spearman method was used to analyze the correlation between life quality score, cervical sagittal parameters and CCR. Results:VAS in control group 1.4±0.9 was lower than that in kyphosis group (2.3±0.7), and therewasno statistically significant difference ( t=3.71, P=0.30). NDI in control group (4.3%±2.5%) was significantly lower than that in kyphosis group (5.8%±1.7%), and the difference was statistically significant ( t=2.60, P=0.04). CL in control group (-18.76°±2.43°) was significantly lower than that in kyphosis group (13.80°±7.59°) ( t=3.43, P<0.01). SCA in control group (85.94°±4.52°) was significantly higher than that in kyphosis group (84.07°±10.44°) ( t=0.95, P<0.01). T 1S in control group (24.00°±2.85°) was significantly higher than that of kyphosis group (15.47°±11.33°) ( t=4.25, P<0.01), and C 2-C 7 SVA of control group (30.35±6.59 mm) was significantly higher than that in kyphosis group (19.08±14.47 mm) ( t=4.09, P<0.01). ROM in control group (50.23°±3.07°) was significantly higher than that in kyphosis group (45.63°±11.73°) ( t=2.21, P<0.01). CCR from neutral to flexion movement (CCRNF) was significantly lower in control group (0.46±0.20) than kyphosis group (0.84±0.13)( t=12.61, P=0.005), CCR from extension to neutral movement (CCREN) was significantly lower in control group (0.55±0.21) than in kyphosis group (0.79±0.16) ( t=7.10, P=0.042). CCRNF was significantly correlated with VAS ( r=0.504), NDI ( r=0.322), CL ( r=-0.240), T 1S ( r=-0.591), C 2-C 7 SVA ( r=-0.474) and ROM ( r=-0.303, P<0.05). There were significant correlations between CCREN and VAS ( r=0.339), NDI ( r=0.243), CL ( r=-0.347), T 1S ( r=-0.341), C 2-C 7 SVA ( r=-0.346) and ROM ( r=-0.065) ( P<0.05). However, there was no significant difference between CCR and SCA ( P>0.05). Conclusion:SEMG canbe an objective tool to evaluate the degree of neck pain and neck disability index. During cervical flexion movement, patients with cervical kyphosis had more tensional cervical extensor muscle and worse muscle function.