Systems and methods for anatomical alignment are disclosed herein. In some embodiments, the systems and methods can provide accurate and continuous intraoperative validation of anatomical alignment, e.g., of the spine, hips, pelvis, and/or shoulders. An exemplary system can include a sensor and marker arrangement for measuring coronal imbalance. Another exemplary system can include a sensor and marker arrangement for shoulder or pelvic leveling. Yet another exemplary system can include a mechanical frame for establishing a simulated ground plane and projecting a plumb line from the simulated ground plane.