Cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis and assessment of its alteration with surgery: a retrospective, multi-centric study



To document baseline cervical sagittal characteristics in Lenke 1 adolescent idiopathic scoliosis (AIS) patients and assess the alteration in these parameters with surgery.


Pre-operative and 2-year postoperative radiographs of 82 Lenke 1 AIS patients recruited from five hospitals were analysed. Selected radiographic parameters capturing regional and global sagittal alignment were measured. Comparison was made between groups based on baseline thoracic kyphosis (TK: TK < 20°, TK ≥ 20°). Pre-operative and postoperative values were compared—the change in each radiographic parameter was correlated with the degree of sagittal and coronal correction.


At baseline, TK was 29.8° ± 16°, cervical lordosis (CL) was − 1° ± 14°, lumbar lordosis (LL) was − 57.1° ± 21°, C2–C7 sagittal vertical axis (SVA) was 16 ± 14 mm and C7–S1 SVA was − 15 ± 28 mm; 44% of patients had cervical kyphosis. Patients with thoracic hypokyphosis had a significantly lower LL and more kyphotic cervical spine compared to those with thoracic normohyperkyphosis. The effect of surgery on TK depended on pre-operative thoracic sagittal alignment—TK increased in patients with thoracic hypokyphosis, but decreased in patients with thoracic normohyperkyphosis. Neither CL nor C2–C7 SVA changed significantly with surgery; 46% of patients still had cervical kyphosis postoperatively.


There is a high incidence of cervical kyphosis at baseline in AIS patients—more so in those with pre-operative thoracic hypokyphosis. Unlike TK, CL is not significantly altered with surgery—improvement in CL correlates weakly with sagittal correction of the structural curve.

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Concepts: BG, NM, AG, APS, SB, SJ, SDG, JNB, HSC; Design: BG, NM, AG, APS, SB; Definition of intellectual conten: BG, NM, PAS, SJ, SDG; Literature search: NM, AG, PAS, SJ, SDG; Data acquisition: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Data analysis: NM, AG, APS, SB, SJ, SDG; Statistical analysis: NM, AG, PAS; Manuscript preparation: NM; Manuscript editing: BG, NM, AG, APS, SB, HSC; Manuscript review: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Approval of final manuscript: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Agree to be accountable for all aspects of work: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC.

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Correspondence to Nishank Mehta.

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Approval was obtained from the Institutional Ethics Committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Garg, B., Mehta, N., Gupta, A. et al. Cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis and assessment of its alteration with surgery: a retrospective, multi-centric study. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00366-8

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  • Adolescent idiopathic scoliosis
  • AIS
  • Cervical lordosis
  • Cervical spine alignment
  • Thoracic kyphosis
  • Sagittal alignment
  • Scoliosis
  • Spinal balance