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  • Writer's pictureDr. Brandon J. Van Seters, DC

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)

Sagittal spinal alignment
Coronal Spinal Alignment

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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Gong, H., Sun, L., Yang, R. et al. Changes of upright body posture in the sagittal plane of men and women occurring with aging – a cross sectional study. BMC Geriatr. 2019; 19: 71.

Ferrero E, et al. Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity. J Neurosurg Spine. 2016; 24:436-446.

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.

Keenan, B.E., Pettet, G.J., Izatt, M.T. et al. Gravity-induced coronal plane joint moments in adolescent idiopathic scoliosis. Scoliosis. 2015; 10: 35.

Keller TS, et al. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. The Spine Journal. 2005; 5(3): 297-309.

Kim, YE & Choi, HW. Effect of disc degeneration on the muscle recruitment pattern in upright posture: a computational analysis. Computer methods in biomechanics and biomedical engineering. 2015; 18:1622-1631.

Kumar NM, et al. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. European Spine Journal. 2001; 10(4):314-319.

Ohnishi T, et al. Impact of spino-pelvic and global spinal alignment on the risk of osteoporotic vertebral collapse. Spine Surg Relat Res. 2018; 2(1)-72-76.

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.

Tsuji T., Matsuyama Y., Goto M. Knee–spine syndrome: correlation between sacral inclination and patellofemoral joint pain. J Orthop Sci. 2002;7:519–523.


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