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Not all degenerated discs result in disc\u2010displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is \u201cfixed parameter\u201d since skeletal maturity. No study has addressed disc\u2010displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically\u2010relevant MRI\u2010phenotypes. One hundred and eight population\u2010based subjects (mean age: 52.3\u2009years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc\u2010displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc\u2010displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL\/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95\u20100.92; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05), with critical PI value of 42\u00b0 or lower exhibiting fourfold increase risk of combined phenotypes (<jats:italic>P<\/jats:italic> = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc\u2010displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may \u201cpredict\u201d the development of disc\u2010displacement, MCs and UDS, suggesting potential sub\u2010variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An \u201cevolutionary etiological pathway\u201d of spinal phenotype development is proposed.<\/jats:p>","DOI":"10.1002\/jsp2.1083","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T20:09:06Z","timestamp":1582142946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically\u2010relevant spinal phenotypes"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3051-4200","authenticated-orcid":false,"given":"Uruj","family":"Zehra","sequence":"first","affiliation":[{"name":"Department of Anatomy University of Health Sciences  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P. 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