Although the normal sagittal profile of the thoracolumbar spine has been described, this has been obtained primarily by using young individuals standing. We sought to describe the sagittal profile of the thoracolumbar spine in an older population in the supine cross-table lateral position compared with that standing. We enrolled 50 volunteers with no history of back pain or spine deformity and 50 matched subjects with mechanical back pain (LBP) only. Lateral radiographs of the thoracolumbar spine (T10-S1) in both standing and cross-table supine positions were obtained. Lordosis from L1 to S1, kyphosis from T10 to L1, and the changes seen moving from the supine position to standing were calculated. There were few differences comparing the two groups in either the standing or cross-table supine position, or when changing positions. Within each group, however, there were small, but significant, differences in the midlumbar and thoracolumbar spine when comparing supine versus standing. Both asymptomatic individuals and those with a history of LBP demonstrated similar small but statistically significant increases in lumbar lordosis and thoracolumbar kyphosis when standing versus supine. The clinical significance of these findings remains to be determined.