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Updated: May 30, 2025

A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

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T-Bar Angular Offset: A Novel Angle for Predicting Postoperative Coronal Balance Using Intraoperative Stitched

James J Zhou¹, S Harrison Farber, Timothy C Gooldy

¹Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA.

Operative Neurosurgery (Hagerstown, Md.)

|January 30, 2025

Summary

The T-bar angular offset (TAO) effectively predicts upper instrumented vertebra positioning during spinal fusion surgery using intraoperative stitched radiography. However, TAO does not reliably predict C7 coronal alignment in adult spinal deformity cases.

Keywords:

Alignment Balance Coronal Deformity Intraoperative Spine Stitched

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Area of Science:

Spine surgery
Orthopedic surgery
Radiographic assessment

Background:

Accurate intraoperative coronal alignment assessment is crucial for adult spinal deformity surgery outcomes.
Surgical positioning complicates the prediction of standing coronal alignment.
Intraoperative stitched radiography (ISR) is an alternative to cumbersome 36-inch films but has limitations in measuring absolute distances.

Purpose of the Study:

To introduce and evaluate the T-bar angular offset (TAO) as a novel angle for assessing coronal balance on ISR.
To determine if TAO measured during surgery can predict postoperative coronal balance.

Main Methods:

Retrospective review of patients undergoing spinal fusion with ISR.
Creation of a virtual T-bar using S1 endplate and acetabular lines.
Measurement of UIV TAO and C7 TAO angles intraoperatively.

Main Results:

Intraoperative UIV TAO showed significant correlation with postoperative UIV TAO (R=0.695, P<.001) and UIV central sacral vertical line (R=0.435, P=.002).
Intraoperative C7 TAO did not correlate with postoperative C7 TAO (R=0.213, P=.22) or C7 central sacral vertical line (R=0.063, P=.72).

Conclusions:

TAO is a valuable angular measurement on noncalibrated ISR for predicting upper instrumented vertebra positioning relative to the sacrum during spinal fusion.
TAO is not a reliable predictor of C7 coronal alignment in this context.