Sagittal Alignment in Cervical Spine Fusion: Principles, Parameters, and Surgical Implications.

➢ Cervical sagittal alignment is associated with patient-reported outcomes, with higher T1 slope-cervical lordosis mismatch and greater C2-C7 sagittal vertical axis correlating with greater disability and worse health-related quality of life.➢ Cervical alignment must be interpreted alongside global sagittal balance, as cervical posture interacts with thoracic and spinopelvic alignment and compensatory mechanisms.➢ Both anterior and posterior cervical fusion can influence sagittal alignment, but optimal outcomes depend on alignment-conscious planning tailored to deformity morphology and spinal flexibility.➢ Preserving or restoring physiologic cervical alignment reduces the risk of postoperative imbalance and adjacent-segment disease, supporting alignment-guided surgical decision-making.