Sagittal balance of the spine

Eur Spine J. 2019 Sep;28(9):1889-1905. doi: 10.1007/s00586-019-06083-1. Epub 2019 Jul 22.


The static sagittal balance of the normal spine is a physiological alignment of the spine in the most efficient manner by the muscular forces. During gait, this balance is constantly thwarted by single-foot support. This analysis involves the study of parameters which are now well defined. The pelvic incidence is constant, and the sacral slope and the pelvic tilt are positional. The cervical parameters are the upper (O-C2) and lower cervical curvatures (C2-C7), the C7 slope, the spino-cranial angle and the vertical cervical offset. At the thoracic and lumbar level, they are, respectively, kyphosis and lordosis. The OD-HA (odontoid hip axis) angle is the most efficient parameter to analyse the global balance. The average values of these parameters are reported with the new 3D measurements by Le Huec et al. The relationship between these different parameters was analysed, and Roussouly proposed his classification of the different spine shape. Ageing makes it possible to show compensation mechanisms at three levels: spinal, pelvic and lower limbs. Understanding these different data allows for better planning of the surgical management of the patients. Global evaluation of the entire spine and the measurement of the aforementioned parameters allow to determine the extent of the correction to be performed during surgery. Taking these parameters into account also enables us to understand the complications involved in this type of surgery: transitional syndromes or junctional syndromes. Integration of these parameters into the study of gait is an area still under investigation. These slides can be retrieved under Electronic Supplementary Material .

Keywords: FBI; Global balance analysis; Junctional syndrome; Lumbar lordosis; Pelvic tilt; Sagittal balance; Spinal balance; Spinal imbalance; Spino-cranial angle; Spino-pelvic parameters.

Publication types

  • Review
  • Video-Audio Media

MeSH terms

  • Gait / physiology
  • Humans
  • Kyphosis / diagnostic imaging
  • Kyphosis / pathology
  • Kyphosis / physiopathology
  • Kyphosis / surgery
  • Lordosis / diagnostic imaging
  • Lordosis / pathology
  • Lordosis / physiopathology
  • Lordosis / surgery
  • Lumbar Vertebrae / anatomy & histology
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / physiology
  • Pelvic Bones / anatomy & histology
  • Pelvic Bones / diagnostic imaging
  • Postural Balance / physiology*
  • Posture / physiology
  • Radiography
  • Sacrum / anatomy & histology
  • Sacrum / diagnostic imaging
  • Spine / anatomy & histology*
  • Spine / diagnostic imaging
  • Spine / physiology
  • Spine / surgery
  • Tomography, X-Ray Computed