Sagittal spinal pelvic alignment

Neurosurg Clin N Am. 2013 Apr;24(2):157-62. doi: 10.1016/


The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. Each pelvis dictates the amount of lumbar lordosis required through its morphometric parameter pelvic incidence. The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes.

Publication types

  • Review

MeSH terms

  • Humans
  • Lordosis / diagnostic imaging
  • Lordosis / surgery
  • Orthopedic Procedures
  • Patient Care Planning
  • Pelvis / anatomy & histology*
  • Pelvis / diagnostic imaging
  • Pelvis / surgery
  • Radiography
  • Spinal Diseases / diagnostic imaging
  • Spinal Diseases / surgery
  • Spine / anatomy & histology*
  • Spine / diagnostic imaging
  • Spine / surgery
  • Treatment Outcome