JBJS - 2026-08-27 - Journal Article
Principles of Level Selection for Instrumentation in Adult Cervical Spinal Deformity Surgery: Guidelines for Treatment.
Sardar ZM, Coury JR, Bautista AG, Dong K, Riew KD, Reyes JL
Topics
Key Takeaway
Expert consensus guidelines recommend UIV selection of C2 for poor bone health or 3-column osteotomies, and LIV extension to T1–T3 for poor cervical sagittal alignment in adult cervical deformity surgery.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This guideline paper addresses UIV and LIV selection for adult cervical spinal deformity instrumentation. Recommendations stratify UIV choice (C3/C4 vs. C2) by bone quality, construct length, and osteotomy type, and LIV choice (subaxial vs. proximal thoracic vs. thoracolumbar) by sagittal alignment status and presence of concomitant thoracolumbar deformity. No primary outcome data or patient cohort are reported; recommendations are consensus- and principle-based.
Key Limitation
All recommendations are expert consensus without supporting patient-level outcome data, complication rates, or comparative cohort evidence to validate any specific UIV or LIV selection strategy.
Original Abstract
➢ For isolated cervical deformities in patients with good bone health, the upper instrumented vertebra can be C3 or C4.➢ For patients with global cervical deformity, poor bone health, planned 3-column osteotomies, or long fusion constructs, C2 may be an appropriate upper instrumented vertebra.➢ For patients with focal kyphosis, optimal sagittal alignment, and preserved bone stock, a lower instrumented vertebra cranial to the cervicothoracic junction is appropriate.➢ For patients with poor cervical sagittal alignment, a lower instrumented vertebra in the proximal thoracic spine, ranging from T1 to T3, may be appropriate.➢ For combined cervical and thoracolumbar spinal deformities, a lower instrumented vertebra in the lower thoracic or upper lumbar spine is appropriate. The sagittal stable vertebra or first lordotic vertebra concepts can be considered.