Compensatory or pathologic?—cervical spine sagittal alignment in adolescent idiopathic scoliosis

Akbar et al. (1) provide a timely study to further characterize and quantify the sagittal alignment of the cervical spine in children with adolescent idiopathic scoliosis (AIS). Sagittal spinal alignment has been a been a growing area of interest in the field of adolescent spinal deformity. Not only has it been shown to affect clinical outcomes in various populations of adult spinal deformity patients (2,3), it also affects the rate of postoperative complications, including proximal junctional kyphosis and adjacent segment disease (4,5). However, these studies focus largely on the spinopelvic alignment, with the cervical sagittal alignment gaining less attention. Although not a novel investigation, previous studies evaluating cervical sagittal alignment have focused on global parameters and the segmental effects of deformity on the cephalad and caudad alignment of the cervical spine has not been previously assessed. The authors sought to remedy this oversight in the setting of untreated AIS patients.