Skip to main content


Log in

Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript



To analyze pelvic compensation during walking in patients with severe sagittal plane deformity by using motion analysis.


A total of 44 patients with sagittal plane deformity who were scheduled to undergo surgery were included. Motion analysis was performed 3 consecutive times during walking to estimate the anterior pelvic tilt (Ant-PT) angle, trunk kyphosis (TK) angle, and distance of the center of gravity (CoG) from the center of mass (CoM) of the pelvic segment, and hip and knee joint angles during gait. The patients were classified into Ant-PT+/Ant-PT−, TK+/TK−, and CoG+/CoG− groups according to the changes in Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment. Increases and decreases in the values of the variables from the first trial to the third trial were indicated with “+” and “−” signs, respectively.


The mean Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment increased progressively, and the differences in the values of these variables from the first to the third trials were statistically significant (P = 0.046, P = 0.004, and P = 0.007 for the Ant-PT angle, TK angle, and distance of the CoG from the CoM of pelvic segment, respectively). Among the 44 patients, 27 and 34 were classified into the Ant-PT+ and CoG+ groups, respectively. Older age and higher body mass index (BMI) were significantly associated with the Ant-PT+ group. The CoG+ group demonstrated a significantly higher height and weight than the CoG− group.


Higher BMI, height, and weight are risk factors for progressive worsening of dynamic sagittal imbalance.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19(11):1824–1836.

    Article  Google Scholar 

  2. Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(Suppl 5):699–703.

    Article  Google Scholar 

  3. Sengupta DK (2014) Spinopelvic balance. JBJS Rev.

    Article  PubMed  Google Scholar 

  4. Bae J, Theologis AA, Jang JS, Lee SH, Deviren V (2017) Impact of fatigue on maintenance of upright posture: dynamic assessment of sagittal spinal deformity parameters after walking 10 minutes. Spine 42(10):733–739.

    Article  PubMed  Google Scholar 

  5. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34(17):E599–E606.

    Article  PubMed  Google Scholar 

  6. Lafage R, Schwab F, Challier V, Henry JK, Gum J, Smith J, Hostin R, Shaffrey C, Kim HJ, Ames C, Scheer J, Klineberg E, Bess S, Burton D, Lafage V (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine 41(1):62–68.

    Article  PubMed  Google Scholar 

  7. Marks M, Stanford C, Newton P (2009) Which lateral radiographic positioning technique provides the most reliable and functional representation of a patient’s sagittal balance? Spine 34(9):949–954.

    Article  PubMed  Google Scholar 

  8. Marks MC, Stanford CF, Mahar AT, Newton PO (2003) Standing lateral radiographic positioning does not represent customary standing balance. Spine 28(11):1176–1182.

    Article  PubMed  Google Scholar 

  9. Yagi M, Kaneko S, Yato Y, Asazuma T (2017) Standing balance and compensatory mechanisms in patients with adult spinal deformity. Spine 42(10):E584–E591.

    Article  PubMed  Google Scholar 

  10. Scheer JK, Smith JS, Clark AJ, Lafage V, Kim HJ, Rolston JD, Eastlack R, Hart RA, Protopsaltis TS, Kelly MP, Kebaish K, Gupta M, Klineberg E, Hostin R, Shaffrey CI, Schwab F, Ames CP (2015) Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 22(5):540–553.

    Article  PubMed  Google Scholar 

  11. Kim HJ, Shen F, Kang KT, Chun HJ, Kim ST, Chang BS, Lee CK, Yeom JS (2019) Failure of pelvic compensation in patients with severe positive sagittal imbalance: comparison between static radiographs and gait analysis of spinopelvic parameters in adult spinal deformity and lumbar stenosis. Spine.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35(11):1095–1108

    Article  CAS  PubMed  Google Scholar 

  13. Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25(22):2940–2952

    Article  CAS  PubMed  Google Scholar 

  14. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol group. Ann Med 33(5):337–343

    Article  CAS  PubMed  Google Scholar 

  15. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39(4):412–423.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shen F, Kim HJ, Lee NK, Chun HJ, Chang BS, Lee CK, Yeom JS (2018) The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result. Spine J 18(11):2018–2024.

    Article  PubMed  Google Scholar 

  17. Norman K, Stobäus N, Gonzalez MC, Schulzke J-D, Pirlich M (2011) Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 30(2):135–142.

    Article  PubMed  Google Scholar 

  18. de Leva P (1996) Adjustments to Zatsiorsky–Seluyanov’s segment inertia parameters. J Biomech 29(9):1223–1230

    Article  PubMed  Google Scholar 

  19. Le Huec JC, Saddiki R, Franke J, Rigal J, Aunoble S (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(Suppl 5):558–563.

    Article  Google Scholar 

  20. van Wingerden JP, Vleeming A, Buyruk HM, Raissadat K (2004) Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 13(3):199–205.

    Article  Google Scholar 

  21. Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine 26(18):2029–2035

    Article  CAS  PubMed  Google Scholar 

  22. Jalai CM, Diebo BG, Cruz DL, Poorman GW, Vira S, Buckland AJ, Lafage R, Bess S, Errico TJ, Lafage V, Passias PG (2017) The impact of obesity on compensatory mechanisms in response to progressive sagittal malalignment. Spine J 17(5):681–688.

    Article  PubMed  Google Scholar 

  23. Oksuzyan A, Maier H, McGue M, Vaupel JW, Christensen K (2010) Sex differences in the level and rate of change of physical function and grip strength in the Danish 1905-cohort study. J Aging Health 22(5):589–610.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Park S, Kim HJ, Ko BG, Chung JW, Kim SH, Park SH, Lee MH, Yeom JS (2016) The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis. Bone Jt J 98-b(8):1093–1098.

    Article  CAS  Google Scholar 

Download references


This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B3012850) and by Grant Number 14-2018-005 from the SNUBH Research Fund.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jin S. Yeom.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 140 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, HJ., Chun, HJ., Shen, F. et al. Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis. Eur Spine J 29, 428–437 (2020).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: