{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:26:20Z","timestamp":1777591580965,"version":"3.51.4"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>When treating patients with adult spinal deformity (ASD), radiographic measurements evaluating coronal alignment above C7 are lacking. The current objectives were to: 1) describe the new orbital\u2013coronal vertical axis (ORB-CVA) line that evaluates coronal alignment from cranium to sacrum, 2) assess correlation with other radiographic variables, 3) evaluate correlations with patient-reported outcomes (PROs), and 4) compare the ORB-CVA with the standard C7-CVA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective cohort study of patients with ASD from a single institution was undertaken. Traditional C7-CVA measurements were obtained. The ORB-CVA was defined as the distance between the central sacral vertical line and the vertical line from the midpoint between the medial orbital walls. The ORB-CVA was correlated using traditional coronal measurements, including C7-CVA, maximum coronal Cobb angle, pelvic obliquity, leg length discrepancy (LLD), and coronal malalignment (CM), defined as a C7-CVA &gt; 3 cm. Clinical improvement was analyzed as: 1) group means, 2) minimal clinically important difference (MCID), and 3) minimal symptom scale (MSS) (Oswestry Disability Index &lt; 20 or Scoliosis Research Society\u201322r Instrument [SRS-22r] pain + function domains &gt; 8).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 243 patients underwent ASD surgery, and 175 had a 2-year follow-up. Of the 243 patients, 90 (37%) had preoperative CM. The mean (range) ORB-CVA at each time point was as follows: preoperatively, 2.9 \u00b1 3.1 cm (\u221214.2 to 25.6 cm); 1 year postoperatively, 2.0 \u00b1 1.6 cm (\u221212.4 to 6.7 cm); and 2 years postoperatively, 1.8 \u00b1 1.7 cm (\u22126.0 to 11.1 cm) (p &lt; 0.001 from preoperatively to 1 and 2 years). Preoperative ORB-CVA correlated best with C7-CVA (r = 0.842, p &lt; 0.001), maximum coronal Cobb angle (r = 0.166, p = 0.010), pelvic obliquity (r = 0.293, p &lt; 0.001), and LLD (r = 0.158, p = 0.006). Postoperatively, the ORB-CVA correlated only with C7-CVA (r = 0.629, p &lt; 0.001) and LLD (r = 0.153, p = 0.017). Overall, 155 patients (63.8%) had an ORB-CVA that was \u2265 5 mm different from C7-CVA. The ORB-CVA correlated as well and sometimes better than C7-CVA with SRS-22r subdomains. After multivariate logistic regression, a greater ORB-CVA was associated with increased odds of complication, whereas C7-CVA was not associated with any of the three clinical outcomes (complication, readmission, reoperation). A larger difference between the ORB-CVA and C7-CVA was significantly associated with readmission and reoperation after univariate and multivariate logistic regression analyses. A threshold of \u2265 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The ORB-CVA correlated well with known coronal measurements and PROs. ORB-CVA was independently associated with increased odds of complication, whereas C7-CVA was not associated with any outcomes. A \u2265 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.1.spine211527","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T12:55:13Z","timestamp":1650027313000},"page":"410-419","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation of coronal alignment from the skull using the novel orbital\u2013coronal vertical axis line"],"prefix":"10.3171","volume":"37","author":[{"given":"Scott L.","family":"Zuckerman","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hani","family":"Chanbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fthimnir M.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mena G.","family":"Kerolus","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex S.","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian A.","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan","family":"Cerpa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald A.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Spine (Phila Pa 1976).","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab F","year":"2012","unstructured":"Schwab F, Ungar B, Blondel B,  Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. 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