Study DesignSystematic Review.ObjectivesCervicothoracic junction (CTJ) deformities, particularly kyphosis, significantly impact patients' quality of life, causing pain, dysphagia, and inability to maintain horizontal gaze. Various surgical osteotomy techniques are available to correct CTJ kyphosis, but their relative effectiveness and associated complications remain unclear. This systematic review and meta-analysis aim to provide an evidence-based comparison of different surgical techniques for correcting cervicothoracic sagittal imbalance.MethodsA comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted up to August 2024. Studies included in the analysis involved adult patients undergoing cervical or upper thoracic osteotomy for sagittal imbalance correction. Data on radiographic outcomes, complication rates, and surgical factors were extracted and analyzed using random-effects models. Publication bias and heterogeneity were assessed using Begg's test and I