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Malalignment of DHS extended not only to cervical spine but also to cranio-cervical junction and thoracic spine, except T1-T4. It is known that global sagittal spinal alignment is correlated with adjacent parameters, although in DHS the reciprocal change was lost from cranio-cervical junction to the middle part of thoracic spine at cervical flexion. Malalignment of DHS extended not only to cervical spine but also to cranio-cervical junction and thoracic spine, except T1-T4. It is known that global sagittal spinal alignment is correlate