Coronal Balance of the Spine

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The coronal C7 plumb line is neutral if is passes within 2cm of the midline
Scoliosis measurements

Coronal balance is one of the features that needs to be assessed on long spine radiographs obtained for spinal deformity, particularly scoliosis. It measures whether or not the upper spine is located over the midline (normal) or off to one side.


Plumb Line

To assess coronal balance, a vertical (plumb) line is drawn downwards from the mid-point of the C7 vertebral body (exactly in the same way as for the assessment of sagittal balance). This needs to be performed on erect full-length spine radiographs without lateral bending. The horizontal distance between this plumb line and the midline of the sacrum or central sacral vertical line is measured.

The position of this line can then termed positive, neutral or negative, depending on distance and direction from the midline:

  • positive balance: โ€‹the plumb line passes to the right of the midline, by >2 cm
  • neutral balance: the plumb line passes within 2 cm of the midline
  • negative balance: the plumb line passes to the left of the midline, by >2 cm

Central Sacral Vertical Line

The central sacral vertical line (CSVL) is used in the assessment of spinal scoliosis.

It is a line constructed on frontal films of the spine and pelvis to measure coronal balance, drawn as follows:

  1. a line connecting the top of the iliac crests is drawn
  2. a second line is drawn perpendicular to the first, which bisects the sacrum

See Also


Part or all of this article or section is derived from Coronal balance by Dr Henry Knipe and Assoc Prof Frank Gaillard et al., used under CC BY-NC-SA 3.0