**Abstract**

Distal junctional kyphosis (DJK) is a major concern following cervical deformity (CD) correction, leading to failed realignment and revision surgery. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. In this chapter, we describe our approach to the treatment of cervical deformity and the steps taken to minimize the risk of DJK post-operatively by tailoring the construction to the individual patient. First we focus on characterization of the baseline deformity. Secondly, we assess our patients clinically. Thirdly, we simulate the correction with the use of novel in-construct measurements. The fourth step is to develop a DJK prevention strategy tailored to the individual. The last step is to perform surgery and check correction during the operation.

**Keywords:** cervical deformity, DJK, distal junctional kyphosis, DJK prevention, in-construct measurements, cervical deformity correction
