Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets

Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curva-ture and cervical spine alignment. It can lead to a multitude of symptoms, including chron-ic pain, neurological deficits, and functional impairments, severely impacting an individu-al's health-related quality of life (HRQoL). Surgical intervention is often necessary to ad-dress the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhanc-ing readers' understanding of the complexities involved. We begin by discussing the impor-tance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision -making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers' knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.