Scott L. Zuckerman, Zeeshan M. Sardar, Christopher S. Lai, Gerard F. Marciano, Mena G. Kerolus, Ian A. Buchanan, Alex S. Ha, Meghan Cerpa, Michael P. Kelly, Stéphane Bourret, Kazuhiro Hasegawa, Hee-Kit Wong, Gabriel Liu, Hwee Weng Dennis Hey, Hend Riahi, Jean-Charles Le Huec, Lawrence G. Lenke

May 2021, pp 1 - 8 Original Article Read Full Article 10.1007/s00586-021-06873-6

First Online: 19 May 2021


In a population of asymptomatic volunteers across 5 countries, we sought to: (a) establish normative values of the Odontoid-Central Sacral Vertical Line (OD-CSVL) across patient factors, and (b) assess correlations of OD-CSVL with other radiographic parameters.


A prospective, cross-sectional study of asymptomatic adult volunteers, ages 18–80 years, were enrolled across 5 countries (France, Japan, Singapore, Tunisia, United States) forming the Multi-Ethnic Alignment Normative Study (MEANS) cohort. Included volunteers had no known spinal disorder(s), no significant neck/back pain (VAS ≤ 2; ODI ≤ 20), and no significant scoliosis (Cobb ≤ 20°). Radiographic measurements included commonly used coronal alignment parameters (mm) and angles (°). OD-CSVL was defined as the difference between the odontoid plumb line (line from the tip of the odontoid vertically down) and the CSVL (vertical line from the center of the sacrum). Chi-square, student’s t tests, Kruskal–Wallis, Wilcoxon rank-sum, linear regression, and Pearson’s correlation were used with significance at p 


467 volunteers were included with normative OD-CSVL values by age decade, gender, BMI, and country. Mean ± SD OD-CSVL was 8.3 mm ± 6.5 mm and 31 (6.6%) volunteers were almost perfectly aligned (OD-CSVL 


Among asymptomatic volunteers, increased OD-CSVL was significantly associated with increased age, increased BMI, and ethnicity, but not gender. OD-CSVL correlated strongest with C7-CSVL, TL cobb angle, OD-knee, and CAM-knee. OD-CSVL. These results support further study of OD-CSVL in symptomatic adult spine deformity patients.

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