Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine.
The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine.
Material and methods
According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine.
The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.
Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Barrey C (2004) Equilibre sagittal pelvi-rachidien et pathologies lombaires dégénératives. Etude comparative à propos de 100 cas (in French). Thèse de Médecine. Université Claude Bernard, Lyon
Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J 16:1459–1467
Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47
During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A (1985) Towards standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 10:83–87
Duval-Beaupère G, Legaye J (2004) Composante sagittale de la statique rachidienne (in French). Rev Rhum 71:105–119
Gelb DE, Lenke LG, Bridwell KH, Blanke K, MacEnery KW (1995) An analysis of sagittal spinal aligment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358
Izumi Y, Kumano K (2001) Analysis of sagittal lumbar alignment before and after posterior instrumentation: risk factor for adjacent unfused segment. Eur J Orthop Surg Traum 1:9–13
Jackson RP, MacManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex and size. Spine 19:1611–1618
Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586
Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine 29:671–676
Korovessis PG, Stamatakis MV, Baikousis AG (1998) Reciprocal angulation of vertebral bodies in the sagittal plane in a asymptomatic greek population. Spine 23:700–704
Korovessis PG, Dimas A, Iliopoulos P, Lambiris E (2002) Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain. J Spinal Disord Tech 15:384–390
Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319
Lafage V, Schwab F, Skalli W, Hawkinson N, Gagey PM, Ondra S, Farcy JP (2008) Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine 33:1572–1578
Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl):27–31
Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55
Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103
Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(Suppl 5):681–685
Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The importance of spinopelvic parameters in patients with lumbar disc lesions. Int Orthop 26:104–108
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 30:346–353
Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumbline: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325
Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 20:713–719
Stagnara P, De Mauroy JC, Dran G, Gonon G, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342
Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis: clinical, radiological and epidemiological studies. Spine 13:1317–1326
Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87
We express our gratitude to Ms Chantal Silarakis, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, France, for her assistance in paper’s translation.
Conflict of interest
About this article
Cite this article
Barrey, C., Roussouly, P., Le Huec, JC. et al. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22, 834–841 (2013). https://doi.org/10.1007/s00586-013-3030-z
- Sagittal balance
- Spinal alignment
- Lumbar lordosis
- Degenerative disc disease
- Lumbar kyphosis