European Spine Journal

, Volume 27, Issue 8, pp 2012–2013 | Cite as

Reviewer’s comment concerning “Classification of normal sagittal spine alignment: refounding the Roussouly classification” by F. Laouissat et al. (2017). doi:10.1007/s00586-017-5111-x (Epub ahead of print)

  • Pedro Berjano
Reviewer's Comment

Twelve years after the publication of the original Roussouly’s classification [1] of sagittal alignment types in the normal spine, the concepts originally defined by Pierre Roussouly are not widely utilized by surgeons in the diagnosis and treatment of patients with spinal pathology.

Roussouly originally described how the sagittal alignment changes among normal subjects based on some concepts:
  • Increasing pelvic incidence causes increasing sacral slope values in normal individuals. Thus, his original classification was based primarily on the magnitude of sacral slope.

  • Within a given range of sacral slope (and thus of pelvic incidence), the architecture of the spine can be defined, regarding the number of vertebrae included in the lumbar lordosis, the position of the apex of the lumbar lordosis and the position of the inflection point (change from lordosis to kyphosis), which defines the number of vertebrae included in the kyphosis (that can be thoracic or also include some of the upper...


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Conflict of interest

The author declares that he has no competing interests.


  1. 1.
    Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353CrossRefPubMedGoogle Scholar
  2. 2.
    Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2017) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. Google Scholar
  3. 3.
    Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20(Suppl 5):609–618. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Maillot C, Ferrero E, Fort D, Heyberger C, Le Huec JC (2015) Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops(®). Eur Spine J 24(7):1574–1581. CrossRefPubMedGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.IRCCS Istituto Ortopedico GaleazziMilanItaly

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