Cervical deformity correction: comparison of neurological, radiographic, and patient-reported outcome measures by three-column osteotomy level

J Neurosurg Spine 43:433–442, 2025

Three-column osteotomy (3CO) for cervical deformity at C7–T1 is linked to higher neurological deficits, less radiographic correction, and worse Neck Disability Index outcomes compared to T2–6 levels. Surgeons should prefer 3CO below T1 when feasible for better neurological and functional results.

• Study compared outcomes of three-column osteotomy (3CO) for cervical deformity at C7–T1 vs T2–6 levels.

• Patients with 3CO at C7–T1 had higher rates of new postoperative neurological deficits (56% vs 18%).

• T2–6 3CO resulted in greater radiographic correction (T1 slope and C2–T4 SVA) than C7–T1 3CO.

• Neck Disability Index (NDI) improved after T2–6 3CO but worsened after C7–T1 3CO at 1 year.

• All patients with neurological deficits had at least partial recovery; 20% achieved complete recovery.

• 3CO level selection is multifactorial, but caudal to T1 is recommended when feasible due to better outcomes.

• Study limitations include retrospective design and single-institution data.

• Largest study to date comparing neurological, radiographic, and patient-reported outcomes by 3CO level.