J Neurosurg Spine 44:858–865, 2026
This clinical retrospective study evaluates whether the chin-brow vertical angle (CBVA) reliably predicts the osteotomized vertebra angle (OVA) when planning pedicle subtraction osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis. Patients were stratified by cervical range of motion (CROM) and radiographic changes in CBVA, cervical Cobb angles, and global sagittal parameters were analyzed.
Results show a strong correlation between ΔCBVA and OVA in patients with limited CROM (≤20°), but no correlation when CROM exceeded 20°, indicating that CBVA alone is unreliable for OVA design in patients with flexible cervical spines. The study recommends considering cervical mobility when selecting OVA planning methods and suggests supplementing CBVA with measures of cervical compensation in flexible cases.
Objective Examine how well CBVA predicts needed correction (OVA) in ankylosing spondylitis (AS) thoracolumbar kyphosis across different cervical range of motion (CROM) values.
Design/Groups Retrospective cohort of AS patients undergoing single-level thoracic or lumbar pedicle subtraction osteotomy (PSO) (2015–2019) with ≥2-year follow-up; grouped by CROM: ≤10°, 10–20°, and >20°.
Key finding (CROM ≤20°) Strong correlation between ΔCBVA (preop→immediate postop) and OVA in CROM ≤10° and 10–20° groups (r = 0.881 and 0.932; both p < 0.001), supporting CBVA-based planning when cervical motion is limited.
Key finding (CROM >20°) No correlation between ΔCBVA and OVA when CROM > 20° (r = 0.198, p = 0.314), and most patients (89%) had ΔCBVA smaller than OVA, implying undercorrection risk if CBVA alone guides OVA.
Cervical adaptation mechanism With higher cervical mobility, postoperative cervical alignment changes substantially (CNA group cervical kyphosis change 20.25° vs 4.97° in CA), which can blunt CBVA change despite large osteotomy correction.
Improved predictor Adding cervical alignment change (ΔCobb C0–7) to CBVA change yields closer agreement with OVA (ΔCobb C0–7 + ΔCBVA correlated with OVA in both CA and CNA groups; CA r = 0.87 p < 0.001; CNA r = 0.38 p = 0.044).
Clinical recommendation CBVA is not consistently reliable for OVA design; it is not recommended as a guiding parameter when CROM > 20°.
Outcomes Both cervical-ankylosis–range (CROM ≤20°) and nonankylosis–range (CROM >20°) subgroups achieved satisfactory orthopedic improvement after surgery despite differences in cervical compensation.
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