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.

Background: Neurodegenerative diseases are disorders in which nerve cells start to lose function due to different causes. Like many other illnesses, they are considered to be highly prevalent in the 22 Arabicspeaking countries known to constitute the Arab world. The two most prevalent neurodegenerative disorders are Alzheimer's disease and Parkinson's disease.Aim: The aim of this paper is to assess the amount of research dedicated to neurodegenerative diseases by the Arab countries during a 15-year period, between 2005 and 2019.Methods: The number of publications by each Arab country as well as some non-Arab speaking countries was retrieved from PubMed. Publications in top 10 neuroscience journals were also tracked using the same method with each journal's name included. The numbers were then normalized with respect to the average population and average gross domestic product (GDP) in each country to eliminate bias.Results: Arab countries were shown to contribute only 1,311 (0.774%) of the 169,330 articles published worldwide on neurodegenerative disorders. These 1,311 also constitute only 0.660% of the 198,869 Arab publications during the indicated period. Saudi Arabia had the highest contribution to these numbers with more than one-quarter the number of publications on neurodegenerative disorders. Approximately onethird of all neurodegenerative disease-related articles were associated with Alzheimer's disease, whereas one-fifth were related to Parkinson's disease. For the top 10 neuroscience journals, only a minimal contribution by Arab countries was noted. Conclusion:Although an increase in the number of articles by the Arab world was noted from 2013 onward, the contribution of the Arab countries on the subject to the number of publications still seems to be insufficient.

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