PMID- 35364571 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 37 IP - 3 DP - 2022 Sep 1 TI - Evaluation of coronal alignment from the skull using the novel orbital-coronal vertical axis line. PG - 410-419 LID - 10.3171/2022.1.SPINE211527 [doi] AB - OBJECTIVE: 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-coronal 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. METHODS: 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 > 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 < 20 or Scoliosis Research Society-22r Instrument [SRS-22r] pain + function domains > 8). RESULTS: 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 +/- 3.1 cm (-14.2 to 25.6 cm); 1 year postoperatively, 2.0 +/- 1.6 cm (-12.4 to 6.7 cm); and 2 years postoperatively, 1.8 +/- 1.7 cm (-6.0 to 11.1 cm) (p < 0.001 from preoperatively to 1 and 2 years). Preoperative ORB-CVA correlated best with C7-CVA (r = 0.842, p < 0.001), maximum coronal Cobb angle (r = 0.166, p = 0.010), pelvic obliquity (r = 0.293, p < 0.001), and LLD (r = 0.158, p = 0.006). Postoperatively, the ORB-CVA correlated only with C7-CVA (r = 0.629, p < 0.001) and LLD (r = 0.153, p = 0.017). Overall, 155 patients (63.8%) had an ORB-CVA that was >/= 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 >/= 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes. CONCLUSIONS: 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 >/= 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes. FAU - Zuckerman, Scott L AU - Zuckerman SL AD - 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. AD - 2Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and. FAU - Chanbour, Hani AU - Chanbour H AD - 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Hassan, Fthimnir M AU - Hassan FM AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Lai, Christopher S AU - Lai CS AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Shen, Yong AU - Shen Y AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Lee, Nathan J AU - Lee NJ AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Kerolus, Mena G AU - Kerolus MG AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Ha, Alex S AU - Ha AS AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Buchanan, Ian A AU - Buchanan IA AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Leung, Eric AU - Leung E AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Cerpa, Meghan AU - Cerpa M AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Lehman, Ronald A AU - Lehman RA AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. FAU - Lenke, Lawrence G AU - Lenke LG AD - 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York. LA - eng PT - Journal Article DEP - 20220401 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - adult spinal deformity OT - coronal alignment OT - diagnostic technique OT - orbital-coronal vertical axis EDAT- 2022/04/02 06:00 MHDA- 2022/04/02 06:01 CRDT- 2022/04/01 20:18 PHST- 2021/12/10 00:00 [received] PHST- 2022/01/31 00:00 [accepted] PHST- 2022/04/02 06:01 [medline] PHST- 2022/04/02 06:00 [pubmed] PHST- 2022/04/01 20:18 [entrez] AID - 2022.1.SPINE211527 [pii] AID - 10.3171/2022.1.SPINE211527 [doi] PST - epublish SO - J Neurosurg Spine. 2022 Apr 1;37(3):410-419. doi: 10.3171/2022.1.SPINE211527. Print 2022 Sep 1.