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Evaluation of coronal alignment from the skull using the novel orbital-coronal vertical axis line
Scott L Zuckerman1,2, Hani Chanbour1, Fthimnir M Hassan3
11Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Journal of Neurosurgery. Spine
|April 1, 2022
Summary
A new orbital-coronal vertical axis (ORB-CVA) measurement in adult spinal deformity (ASD) surgery correlates with existing measures and predicts complications. A significant difference between ORB-CVA and C7-CVA indicates poorer outcomes.
Area of Science:
- Orthopedic Surgery
- Spinal Deformity Correction
- Radiographic Analysis
Background:
- Coronal alignment assessment in adult spinal deformity (ASD) is crucial for surgical outcomes.
- Current radiographic measurements, like C7-coronal vertical axis (C7-CVA), may not fully capture craniopelvic alignment.
- A novel measurement is needed to evaluate coronal alignment from the cranium to the sacrum.
Purpose of the Study:
- To introduce and define the orbital-coronal vertical axis (ORB-CVA) for craniosacral coronal alignment.
- To assess the correlation of ORB-CVA with established radiographic parameters in ASD.
- To evaluate the relationship between ORB-CVA and patient-reported outcomes (PROs), and compare it with C7-CVA.
Main Methods:
- Retrospective cohort study of 243 adult spinal deformity patients undergoing surgery.
- ORB-CVA defined as the distance between the central sacral vertical line and a vertical line from the medial orbital walls.
- Correlations performed with C7-CVA, Cobb angle, pelvic obliquity, leg length discrepancy (LLD), and coronal malalignment (CM). Clinical outcomes analyzed using MCID and MSS criteria.
Main Results:
- Preoperative ORB-CVA correlated strongly with C7-CVA (r=0.842) and other coronal parameters.
- Postoperatively, ORB-CVA correlated with C7-CVA and LLD.
- A difference of ≥ 5 mm between ORB-CVA and C7-CVA was observed in 63.8% of patients.
- Greater ORB-CVA was associated with increased complication odds; C7-CVA was not.
- A ≥ 1.5-cm difference between preoperative ORB-CVA and C7-CVA predicted poorer outcomes, including readmission and reoperation.
Conclusions:
- The ORB-CVA is a valuable radiographic measurement for assessing craniosacral coronal alignment in ASD.
- ORB-CVA demonstrates significant correlations with existing radiographic measures and PROs.
- ORB-CVA, particularly a large difference from C7-CVA, is independently associated with adverse surgical outcomes and complications.
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