Importance of Spinal Alignment
Updated: Mar 16, 2022
Optimal spinal alignment refers to proper front to back (sagittal) and balanced side to side (coronal) alignment.
Front to Back Spinal Alignment Side to Side Spinal Alignment
(Sagittal Plane) (Coronal Plane)
Front to Back Alignment/ Sagittal Alignment
Optimal sagittal alignment has been correlated with optimal postural load balance in healthy individuals. Sagittal spinal alignment has been shown to cause compensatory changes in pelvis and lower extremity to maintain upright posture. Better sagittal alignment is correlated with increased function, physical performance and quality of life in the elderly population. Knee osteoarthritis and pain has also been correlated with sagittal spinal alignment known as Knee-Spine Syndrome. Patients who under went lumbar fusion surgery had a lower incidence of adjacent segment degeneration in a 5 year follow up if they had better sagittal alignment. Sagittal alignment is also a significant risk factor for osteoporotic vertebral collapse.
Side to Side Alignment/ Coronal Alignment
Coronal alignment of the spine has been less studied in the scientific literature however coronal alignment imbalance has been correlated with sagittal alignment imbalance. Extreme cases of coronal spinal imbalance is known as scoliosis. Coronal malalignment can be seen in the mirror looking at shoulder height and hip height. Even though the scientific community has not looked into the significance of coronal spinal Chiropractors have been measuring and correcting this issue for decades. Chiropractors measure global coronal malalignment by measuring functional leg length inequality.
Poor Sagittal Alignment associated with:
Abnormal Postural Load
Compensatory changes in pelvis and lower extremity
Decreased function, physical performance and quality of life in the elderly
Knee osteoarthritis and knee pain
Adjacent segment level degeneration in lumbar fusion
Risk factor for osteoporotic vertebral collapse
Poor Coronal Alignment
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Iyer S, et al. Sagittal Spinal Alignment in adult spinal deformity: an overview of current concepts and a critical analysis review. JBJS Review. 2018; 6(5)e2.
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Tokida R, et al. Association between sagittal spinal alignment and physical function in the Japanese general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. J Bone Joint Surg Am. 2019; 101(18):1698-1706.
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