scholarly journals Correlation between lumbar sagittal alignment, Modic changes, and endplate erosion in patients with degenerative disease

2020 ◽  
Author(s):  
Bin Lv ◽  
Haosheng Wang
Keyword(s):  
Lumbar Lordosis ◽  
Sagittal Alignment ◽  
Modic Changes ◽  
Degenerative Disease ◽  
Defect Group ◽  
Sacral Slope ◽  
Precise Understanding ◽  
Significant Difference ◽  
Before And After ◽  
Operation Results

Abstract Purpose To explore the role of lumbar sagittal alignment in the occurrence of Modicchanges and endplate defects (MC&ED) development in patients with a spinal degenerative disease, and the relationship between lumbar sagittal alignment and patient-report outcomes. Background Increasing attention has been focused on MC&ED as playing a potential role in the etiopathogenesis of lumbar degeneration. The precise understanding of the mechanisms leading to progression of MC&ED is lacking. Hence, we investigated how lumbar sagittal alignment influences the MC&ED. Patients and methods Ninety-six consecutive asymptomatic or symptomatic patients with Modic changes or endplate defect were retrospectively recruited in this study from August 2016 to December 2018. MC&ED were observed in 76 patients and not observed in 20 patients, representing two groups for comparison. The lumbar sagittal parameters were measured, including lumbar lordosis (LL),pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). The lumbar lordosis index (LLI) and idea LL were then calculated. Clinical outcomes were assessed using a visual analog scale(VAS) and a Oswestry Disability Index (ODI) before and after operation. Results There were no significant differences in the distribution of demographics and baseline clinical variables between both groups. Mean age and BMI showed a significant difference between both groups (P<0.05). There were significant correlations between LL, LLI, Lossof LL, and Level 1 (r=0.281, 0.230, and 0.284, P<0.05) Also, PI, PT were significantly correlated with Level 4 (r=0.249, 0.202, P<0.05).Compared with presurgery scores, an improvement was seen in postoperative VAS and ODI scores (P<0.05). Further, the postoperative scores at 24 months in the without Modicor end plate defect group showed greater improvements compared with the with Modic or endplate defect group (P<0.05). Conclusion This analysis indicated that maintaining lumbar sagittal alignment was related to a lower risk of Modic changes in patients with the spinal degenerative disease. The lumbar sagittal alignment might be a factor that influenced the posterior inclination of the pelvis in symptomatic lumbar disease.

scholarly journals Lumbar Sagittal Alignment May Be a Good Predictor for the Lumbar Spine Degeneration

2020 ◽  
Author(s):  
Xingping Xu ◽  
Chao Guo ◽  
Changwei Chen ◽  
Yong Tang ◽  
Fusheng Wang ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Influence Factor ◽  
Sagittal Alignment ◽  
Modic Changes ◽  
Defect Group ◽  
Sacral Slope ◽  
End Plate ◽  
Significant Difference ◽  
Before And After ◽  
Spine Degeneration

Abstract BackgroundIncreasing attention has been focused on (modic changes and end plate defect) MC&ED as a potential role in the etiopathogenesis of lumbar degeneration. The precise mechanism leading to progression of MC&ED is lacking. Some scholars thought lumbar sagittal alignment might be a key influence factor, but without enough clinical evidence. Hence, we investigated how lumbar sagittal alignment influences MC&ED.MethodsNinety-six asymptomatic or symptomatic patients with Modic changes or end plate defect were retrospectively recruited in this study from August 2016 to December 2018. MC&ED were observed in 76 patients and not observed in 20 patients, representing two groups for comparison. The lumbar sagittal parameters were measured, including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). The lumbar lordosis index(LLI) and idea LL were then calculated. Clinical outcomes were assessed using a visual analog scale(VAS) and an Oswestry Disability Index (ODI) before and after an operation.ResultsThere were no significant difference in the distribution of demographic and baseline clinical variables between both groups. Mean age and BMI showed significant difference between both groups (P < 0.05). There were significant correlations between LL, LLI, Loss of LL, and Level 1 (r = 0.281, 0.230, and 0.284, P < 0.05) Also, PI, PT were significantly correlated with Level 4 (r = 0.249, 0.202, P < 0.05). Compared with presurgery scores, an improvement was seen in postoperative VAS and ODI scores (P < 0.05). Further, the postoperative scores at 24 months in the without Modic or end plate defect group showed greater improvements compared with the with Modic or endplate defect group (P < 0.05).ConclusionThis analysis indicated that maintaining lumbar sagittal alignment was related to a lower risk of Modic changes in patients with the spinal degenerative disease. The lumbar sagittal alignment might be a factor that influenced the posterior inclination of the pelvis in symptomatic lumbar disease.

THE EFFECTS OF VARIOUS HEEL SLOPES ON LUMBOSACRAL BIOMECHANICAL ANGLES IN STUDENTS WITH HYPER LORDOSIS

2021 ◽  
Vol 19 (2) ◽  
pp. 209-217
Author(s):  
Hamidreza Saiediborojeni ◽  
Hamideh Mashalchi ◽  
Somayeh Mahdavikian ◽  
Masoud Fallahi ◽  
Soheil Saiediborojeni ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Female Students ◽  
School Age Children ◽  
Sacral Slope ◽  
School Age ◽  
Spinal Disorders ◽  
Parametric Test ◽  
Physical Mobility ◽  
Significant Difference ◽  
Quasi Experimental

Posture disorders in school-age children are highly frequent. Poor movement and lack of physical mobility are the main causes of physical weaknesses. Thus, corrective exercises with the aim of solving these problems are significant. The aim of this study was an evaluation of the effects of various heel slopes on lumbosacral biomechanical angles in students with hyperlordosis. In this quasi-experimental study, 15 female students who were di- agnosed with hyperlordosis, participated in this study. They were divided into 3 groups (n=5) and performed corrective exercises on +3.7°, 0°, and -3.7° slopes for 8 weeks, 3 times a week. The changes in the lumbar lordosis angle (LLA), sacral based angle (SBA), and lumbosacral angle (LSA) were determined. Data were analyzed by SPSS 18 software using non-parametric test followed by the Krus- cal-wallis test. P<0.05 was considered significant. The results indicated no significant difference regarding the changes in LLA, SBA, and LSA in students with hyperlordosis (p>0.05) de- spite the decrease in the means of the angles in all groups. The results showed that by increasing the heel slope, the lumbo - sacral slope decreases also the lumbosacral angle decreases by decreasing the heel slope, this may indicate an association between these angles.The findings can help parents choose more appropriate shoes for their children to both prevent the incidence of posture dis- orders during childhood and spinal disorders in adulthood.

scholarly journals Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Byeong Jin Ha ◽  
Yu Deok Won ◽  
Je Il Ryu ◽  
Myung-Hoon Han ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Alignment ◽  
Multivariate Logistic Regression Analysis ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Fusion ◽  
T1 Slope ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Before And After ◽  
Atlantodental Interval

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2–C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34–15.73; p = 0.015). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

scholarly journals Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Byeong Jin Ha ◽  
Yu Deok Won ◽  
Jeil Ryu ◽  
Myung-Hoon Han ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Alignment ◽  
Multivariate Logistic Regression Analysis ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Fusion ◽  
T1 Slope ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Before And After ◽  
Atlantodental Interval

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.66; 95% confidence interval, 1.37–15.84; p = 0.014). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

scholarly journals Novel Method for Evaluation of Sagittal Spinal Alignment Using Cluster Analysis of Slope of Each Vertebra.

2021 ◽  
Author(s):  
Yoshitaka Matsubayashi ◽  
Yasushi Oshima ◽  
Yuki Taniguchi ◽  
Toru Doi ◽  
So Kato ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Sagittal Alignment ◽  
Thoracolumbar Junction ◽  
Sacral Slope ◽  
Spinal Alignment ◽  
Sagittal Spinal Alignment ◽  
Significant Difference ◽  
Novel Method ◽  
And Cluster Analysis ◽  
Whole Spine

Abstract Background: The parameters of sagittal spinal alignment proposed to date measure only the specific sectional angle or the specific sectional distance of the entire spine. To evaluate the alignment of the entire spine without segmentation, we sought to measure and analyze the slope of each vertebral body from skull to pelvis. The purpose of this study was to confirm the effectiveness of this novel analytic method for the evaluation of spinal alignment that considers the slope of each spinal vertebra using graph and cluster analysis.Methods: Every spinal slope from McGregor’s slope to the sacral slope of 88 patients who underwent standing whole spine radiography was measured. Subsequently, we conducted cluster analysis of each spinal slope to understand the characteristics of sagittal alignment.Results: Cluster analysis of whole spinal slopes did not provide useful results in this study because the number of cases per cluster was small due to the large number of parameters. Therefore, we focused the cluster analysis on only the cervical spine slopes. Then, we categorized cervical alignment into four groups (named Normal, Mismatch, Straight, and Sigmoid) based on the results of the cluster analysis. Patients in the Normal and Mismatch groups were older and had lower lumbar apex (L4), apparent lordo-kyphosis around the thoracolumbar junction, and high thoracic kyphosis (TK). Patients in the straight and sigmoid groups were younger, had a higher lumbar apex (L3), flat thoracolumbar junction, and low TK. There was no significant difference between the four groups with respect to pelvic incidence (PI) or pelvic tilt (PT).Conclusion: We proposed a novel method for visually understanding sagittal alignment. Using this analysis method, differences and similarities of sagittal alignment between each group can be easily identified. More detailed analysis of the whole spine may be possible by increasing the number of cases.

scholarly journals Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Byeong Jin Ha ◽  
Yu Deok Won ◽  
Jeil Ryu ◽  
Myung-Hoon Han ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Alignment ◽  
Multivariate Logistic Regression Analysis ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Fusion ◽  
T1 Slope ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Before And After ◽  
Atlantodental Interval

Abstract Background: Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA).Methods: We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery.Results: The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p=0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (>7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34-15.73; p=0.015).Conclusion: We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (>7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

X-Ray Spectroscopy in the Clinical Laboratory

1960 ◽  
Vol 6 (4) ◽  
pp. 299-313 ◽  
Author(s):  
Samuel Natelson ◽  
Bertrum Sheid
Keyword(s):  
Clinical Laboratory ◽  
Electrophoretic Pattern ◽  
Total Sulfur ◽  
Serum Samples ◽  
X Ray ◽  
Content Ratio ◽  
Accuracy And Precision ◽  
Significant Difference ◽  
Before And After ◽  
Operation Results

Abstract Chlorine and sulfur are assayed in serum with the X-ray spectrometer. The serum samples are dried in confined spots on a long strip of filter paper. The strip is passed continuously through the X-ray field and the element assayed by the peak of the curve drawn on the recorder. An attachment for the spectrometer is described for this purpose, as well as an instrument for making the confined spots. Results for chlorine in serum are compared with those obtained by mercurimetric titration. The results are comparable as regards accuracy and reproducibility. Using 20 µ1. of serum and the automatic feed, the results for chlorine indicate a reproducibility, by X-ray, of ± 3.4 per cent (2σ). No significant difference was observed in comparing the values for sulfur obtained by X-ray with those obtained by ashing and treatment with barium chloranilate. The X-ray technic with 25 µ1. of serum is reproducible to ± 2.2 per cent (2σ). Serum was dialyzed against saline and assayed for sulfur content before and after dialysis. The dialyzable sulfur is small in comparison with the total protein sulfur. In comparing normal and pathologic sera with respect to their sulfur-to-protein content ratio it is observed that this varies apparently because the serum globulins contain amounts of sulfur different from serum albumin. The abnormal protein observed in multiple myeloma contains less than half the sulfur of the albumin from the same patient. This was determined by scanning the electrophoretic pattern of the serum for sulfur and protein. It is pointed out that the X-ray technic is practical for routine analysis in the clinical laboratory in that no reagents are required for total sulfur, chlorine, calcium and potassium; furthermore, only an ultramicrosample is needed and the instrument is easily adapted to automatic operation. Results are comparable with those obtained by conventional methods with regards to accuracy and precision.

Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

2011 ◽  
Vol 14 (2) ◽  
pp. 184-191 ◽  
Author(s):  
Virginie Lafage ◽  
Frank Schwab ◽  
Shaleen Vira ◽  
Robert Hart ◽  
Douglas Burton ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
Significant Difference ◽  
Spinopelvic Parameter ◽  
Spinal Imbalance

Object Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to −4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = −0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = −0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = −0.358, p < 0.005). Conclusions The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

Differences in pelvic parameters among Mexican, Caucasian, and Asian populations

2012 ◽  
Vol 16 (5) ◽  
pp. 516-519 ◽  
Author(s):  
Barón Zárate-Kalfópulos ◽  
Samuel Romero-Vargas ◽  
Eduardo Otero-Cámara ◽  
Victor Correa Correa ◽  
Alejandro Reyes-Sánchez
Keyword(s):  
Lumbar Lordosis ◽  
Asian Population ◽  
Ethnic Origin ◽  
Control Group ◽  
Sacral Slope ◽  
Sample Population ◽  
Lumbosacral Region ◽  
Asian Populations ◽  
Pelvic Parameters ◽  
Significant Difference

Object The aim of this study was to describe the pelvic parameters in a sample of healthy Mexican volunteers and to compare them with previously reported data for Caucasian and Asian populations. Methods This was a transversal study that included a sample population of healthy Mexican volunteers. Age, sex, and lateral radiographs of the lumbosacral region with the individual standing to obtain the pelvic parameters of pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and lumbar lordosis (LL) were recorded in each volunteer. The data were compared with those previously published for Caucasian and Asian individuals. Results In total, 202 Mexican individuals (81 men and 121 women; mean age 46.5 years, range 18–85 years) were included. There were statistically significant differences between the Mexican and Caucasian control group with respect to PT (11.9° vs 15.78°, respectively) and PI (51.91° vs 56.68°, respectively). Comparison with the Asian population showed statistically significant differences in relation to the Mexican group in terms of the PT (11.5° vs 15.78°), PI (47.8° vs 56.68°), and SS (36.3° vs 40.89°). The mean LL was 60.17° for the Mexican group, 52.3° for the Asian group, and 61.3° for the Caucasian group. A significant difference in LL was found between the Mexican and Asian populations (p < 0.0001). Conclusions A comparison of the values for pelvic parameters and lumbar lordosis across the different population samples revealed statistically significant differences, which can be attributed to the ethnic origin of the individuals.

Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome

2007 ◽  
Vol 7 (4) ◽  
pp. 387-392 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee ◽  
Jun-Hong Min ◽  
Dae Hyeon Maeng
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Plumb Line ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spontaneous Correction ◽  
Flat Back ◽  
Lower Lumbar

Object The authors investigate the correlation between thoracic and lumbar curves in patients with degenerative flat back syndrome, and demonstrate the predictability of spontaneous correction of the thoracic curve and sacral angle after surgical restoration of lower lumbar lordosis. Methods The cases of 28 patients treated with combined anterior and posterior spinal arthrodesis were retrospectively reviewed. Inclusion criteria included loss of lower lumbar lordosis resulting in sagittal imbalance. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C-7 plumb line length were measured on pre- and postoperative lateral views of the whole spine. Postoperative changes in thoracic kyphosis, sacral slope, and length of the C-7 plumb line were measured and evaluated according to extent of lumbar lordosis restoration. Results The mean (± standard deviation) preoperative sagittal imbalance was 64.6 ± 63.2 mm, which improved to 15.8 ± 20.7 mm after surgery (p < 0.0001). The preoperative mean lumbar lordosis was 15.6 ± 14.1°, which increased to 40.3 ± 14.5° at follow-up (p < 0.0001). The preoperative mean thoracic kyphosis was 1.6 ± 10.5° and increased to 17.2 ± 12.5° at follow-up (p < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.628, p = 0.0003), and between lordosis and sacral slope (r = 0.647, p = 0.0002). Postoperative correlations also existed between kyphosis and lordosis (r = 0.718, p < 0.0001 and r = 0.690, p < 0.0001, respectively). Conclusions Lower lumbar lordosis plays an important role in sagittal alignment and balance. Surgical restoration of lumbar lordosis results in predictable spontaneous correction of the thoracic curve and sacral slope in patients with degenerative flat back syndrome.

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