Yang X, Bartels RHMA, Donk R, et al. - In this study, sagittal alignment parameters of the cervical spine were assessed in individuals from two randomized double-blind trials on individuals treated by anterior cervical discectomy with or without interbody fusion and arthroplasty for cervical radiculopathy at baseline and a 2-year follow-up. Between the three treatment groups, the cervical sagittal alignment parameters were similar, both at baseline and at 2-year follow-up. C2–C7 lordosis was discovered to progress from 11° to 13°, despite surgical method, however, the other parameters continued to be stable during follow-up. Both at baseline and at 2-year follow-up, only the occipito-cervical angle (OCI) was exhibited to be related to the presence and positive progression of radiological adjacent segment degeneration (ASD). Neck disability index, SF-36 physical-component summary and mental-component summary were demonstrated not to be associated with cervical sagittal alignment. Similarly, a relationship with the value or alteration of the OCI was not present. Therefore, OCI, which is a significant factor to maintain horizontal gaze, was exhibited to be related to radiological ASD, implying that the occipito-cervical angle impacts accelerated cervical degeneration. Moreover, degeneration of the cervical spine could be prognosticated by the value of OCI since OCI did not vary following surgery.