{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:08:46Z","timestamp":1788872926911,"version":"build-2803163510"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001702","name":"AO Foundation","doi-asserted-by":"publisher","award":["AOS-Startup-23-028"],"award-info":[{"award-number":["AOS-Startup-23-028"]}],"id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Observational Case\u2013Control Study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the dynamics of sagittal balance during gait in patients with degenerative spine disease compared with matched controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>33 patients with pathological sagittal balance parameters on standing radiographs and 31 matched controls underwent three-dimensional motion capture analysis during a six-minute walking assessment. Data were collected across five phases: pre-walk, initial-walk, mid-walk, end-walk, and post-walk. Spino-pelvic (pelvic angle, lumbar lordosis, thoracic kyphosis) and sagittal balance parameters (sagittal trunk shift and angle, global tilt), as well as lower limb joint angles were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The greatest decrease in sagittal balance occurred during the transition from standing to walking, with significantly larger changes observed in the study group (C7-L5-sagittal trunk shift increasing from 69.1\u2009\u00b1\u200950.6\u00a0mm to 138.7\u2009\u00b1\u200951.9\u00a0mm) compared to controls (increase from 20.9\u2009\u00b1\u200918.8\u00a0mm to 69.2\u2009\u00b1\u200919.7\u00a0mm; p\u2009=\u20090.020). The decrease was primarily due to increased thoracic kyphosis and, in some cases, reduced pelvic retroversion. During continued walking, sagittal balance remained stable at the group level, with only a subgroup in both groups demonstrating a notable decrease. No significant differences in changes during walking were found between groups. After walking, parameters largely returned close to baseline in a standing position, indicating an almost complete recovery of sagittal balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compensatory mechanisms for maintaining sagittal balance are significantly more effective in a standing position than during walking. While sagittal balance remains stable in most patients during short-term walking, a notable decrease occurred in several individuals. Therefore, further research is needed to identify prognostic factors associated with a decrease in sagittal balance during walking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s43390-026-01347-5","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:52:41Z","timestamp":1775101961000},"page":"1671-1685","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sagittal balance dynamics during gait in patients with degenerative spine disease"],"prefix":"10.1007","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3750-1058","authenticated-orcid":false,"given":"Armand Dominik","family":"\u0160kapin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janez","family":"Vodi\u010dar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matej","family":"Supej","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Verdel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4828-1249","authenticated-orcid":false,"given":"Miha","family":"Vodi\u010dar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"5","key":"1347_CR1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.1.FOCUS13551","volume":"36","author":"CJ Sparrey","year":"2014","unstructured":"Sparrey CJ, Bailey JF, Safaee M et al (2014) Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus 36(5):E1. https:\/\/doi.org\/10.3171\/2014.1.FOCUS13551","journal-title":"Neurosurg Focus"},{"issue":"8","key":"1347_CR2","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1177\/2192568218770769","volume":"8","author":"VM Ravindra","year":"2018","unstructured":"Ravindra VM, Senglaub SS, Rattani A et al (2018) Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J 8(8):784\u2013794. https:\/\/doi.org\/10.1177\/2192568218770769","journal-title":"Global Spine J"},{"issue":"9","key":"1347_CR3","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1007\/s00586-019-06083-1","volume":"28","author":"JC Le Huec","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A (2019) Sagittal balance of the spine. Eur Spine J 28(9):1889\u20131905. https:\/\/doi.org\/10.1007\/s00586-019-06083-1","journal-title":"Eur Spine J"},{"issue":"1S","key":"1347_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2020.102769","volume":"107","author":"K Abelin-Genevois","year":"2021","unstructured":"Abelin-Genevois K (2021) Sagittal balance of the spine. Orthop Traumatol Surg Res 107(1S):102769. https:\/\/doi.org\/10.1016\/j.otsr.2020.102769","journal-title":"Orthop Traumatol Surg Res"},{"issue":"8","key":"1347_CR5","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1177\/21925682221076417","volume":"13","author":"E Cha","year":"2023","unstructured":"Cha E, Park JH (2023) Spinopelvic alignment as a risk factor for poor balance function in low back pain patients. Global Spine J 13(8):2193\u20132200. https:\/\/doi.org\/10.1177\/21925682221076417","journal-title":"Global Spine J"},{"key":"1347_CR6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.gaitpost.2017.04.041","volume":"56","author":"X Cheng","year":"2017","unstructured":"Cheng X, Zhang K, Sun X, Zhao C, Li H, Zhao J (2017) Analysis of compensatory mechanisms in the pelvis and lower extremities in patients with pelvic incidence and lumbar lordosis mismatch. Gait Posture 56:14\u201318. https:\/\/doi.org\/10.1016\/j.gaitpost.2017.04.041","journal-title":"Gait Posture"},{"issue":"8","key":"1347_CR7","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1007\/s00586-016-4648-4","volume":"25","author":"Y Shiba","year":"2016","unstructured":"Shiba Y, Taneichi H, Inami S, Moridaira H, Takeuchi D, Nohara Y (2016) Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis. Eur Spine J 25(8):2572\u20132579. https:\/\/doi.org\/10.1007\/s00586-016-4648-4","journal-title":"Eur Spine J"},{"issue":"13","key":"1347_CR8","doi-asserted-by":"publisher","first-page":"E759","DOI":"10.1097\/BRS.0000000000002985","volume":"44","author":"HJ Kim","year":"2019","unstructured":"Kim HJ, Shen F, Kang KT et al (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 (Phila Pa 1976) 44(13):E759\u2013E765. https:\/\/doi.org\/10.1097\/BRS.0000000000002985","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"1347_CR9","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.jos.2019.01.005","volume":"24","author":"K Kamata","year":"2019","unstructured":"Kamata K, Ozawa H, Sekiguchi Y, Aizawa T, Izumi S, Itoi E (2019) Spino-pelvic- lower extremity balance during walking in elderly patients with spinal kyphosis. J Orthop Sci 24(5):793\u2013797. https:\/\/doi.org\/10.1016\/j.jos.2019.01.005","journal-title":"J Orthop Sci"},{"issue":"1","key":"1347_CR10","doi-asserted-by":"publisher","first-page":"E25","DOI":"10.1097\/BRS.0000000000001709","volume":"42","author":"H Arima","year":"2017","unstructured":"Arima H, Yamato Y, Hasegawa T et al (2017) Discrepancy between standing posture and sagittal balance during walking in adult spinal deformity patients. Spine (Phila Pa 1976) 42(1):E25\u2013E30. https:\/\/doi.org\/10.1097\/BRS.0000000000001709","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"1347_CR11","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1016\/j.spinee.2021.02.017","volume":"21","author":"P Severijns","year":"2021","unstructured":"Severijns P, Moke L, Overbergh T et al (2021) Dynamic sagittal alignment and compensation strategies in adult spinal deformity during walking. Spine J 21(7):1059\u20131071. https:\/\/doi.org\/10.1016\/j.spinee.2021.02.017","journal-title":"Spine J"},{"issue":"4","key":"1347_CR12","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1007\/s00586-020-06312-y","volume":"29","author":"K Miura","year":"2020","unstructured":"Miura K, Kadone H, Koda M et al (2020) Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system. Eur Spine J 29(4):840\u2013848. https:\/\/doi.org\/10.1007\/s00586-020-06312-y","journal-title":"Eur Spine J"},{"issue":"6","key":"1347_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/s25061647","volume":"25","author":"AD \u0160kapin","year":"2025","unstructured":"\u0160kapin AD, Vodi\u010dar J, Verdel N, Supej M, Vodi\u010dar M (2025) Reliability of spino-pelvic and sagittal balance parameters assessed during walking in patients with back pain. Sensors 25(6):1647. https:\/\/doi.org\/10.3390\/s25061647","journal-title":"Sensors"},{"issue":"6","key":"1347_CR14","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.clinbiomech.2011.01.015","volume":"26","author":"A Leardini","year":"2011","unstructured":"Leardini A, Biagi F, Merlo A, Belvedere C, Benedetti MG (2011) Multi-segment trunk kinematics during locomotion and elementary exercises. Clin Biomech 26(6):562\u2013571. https:\/\/doi.org\/10.1016\/j.clinbiomech.2011.01.015","journal-title":"Clin Biomech"},{"issue":"4","key":"1347_CR15","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.gaitpost.2006.12.018","volume":"26","author":"A Leardini","year":"2007","unstructured":"Leardini A, Sawacha Z, Paolini G, Ingrosso S, Nativo R, Benedetti MG (2007) A new anatomically based protocol for gait analysis in children. Gait Posture 26(4):560\u2013571. https:\/\/doi.org\/10.1016\/j.gaitpost.2006.12.018","journal-title":"Gait Posture"},{"key":"1347_CR16","volume-title":"Color Atlas of skeletal landmark definitions. guidelines for reproducible manual and virtual palpations","author":"SV Sint Jan","year":"2007","unstructured":"Sint Jan SV (2007) Color Atlas of skeletal landmark definitions. guidelines for reproducible manual and virtual palpations. Churchill Livingstone, Edinburgh"},{"issue":"5","key":"1347_CR17","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1007\/s00586-009-1249-5","volume":"19","author":"JS Steffen","year":"2010","unstructured":"Steffen JS, Obeid I, Aurouer N et al (2010) 3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers. Eur Spine J 19(5):760\u2013767. https:\/\/doi.org\/10.1007\/s00586-009-1249-5","journal-title":"Eur Spine J"},{"issue":"11","key":"1347_CR18","doi-asserted-by":"publisher","first-page":"3644","DOI":"10.1007\/s00586-016-4649-3","volume":"25","author":"I Obeid","year":"2016","unstructured":"Obeid I, Boissi\u00e8re L, Yilgor C et al (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25(11):3644\u20133649. https:\/\/doi.org\/10.1007\/s00586-016-4649-3","journal-title":"Eur Spine J"},{"issue":"2","key":"1347_CR19","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s00198-015-3283-y","volume":"27","author":"J Fechtenbaum","year":"2016","unstructured":"Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K (2016) Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int 27(2):559\u2013567. https:\/\/doi.org\/10.1007\/s00198-015-3283-y","journal-title":"Osteoporos Int"},{"key":"1347_CR20","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.14728","volume":"11","author":"VF Martins","year":"2023","unstructured":"Martins VF, Tesio L, Simone A, Gon\u00e7alves AK, Peyr\u00e9-Tartaruga LA (2023) Determinants of age-related decline in walking speed in older women. PeerJ 11:e14728. https:\/\/doi.org\/10.7717\/peerj.14728","journal-title":"PeerJ"},{"key":"1347_CR21","doi-asserted-by":"publisher","first-page":"e956","DOI":"10.1016\/j.wneu.2021.11.121","volume":"158","author":"M Ould-Slimane","year":"2022","unstructured":"Ould-Slimane M, Bouyge B, Chastan N et al (2022) Optoelectronic study of gait kinematics in sagittal spinopelvic imbalance. World Neurosurg 158:e956\u2013e963. https:\/\/doi.org\/10.1016\/j.wneu.2021.11.121","journal-title":"World Neurosurg"},{"issue":"7","key":"1347_CR22","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1007\/s00586-022-07199-7","volume":"31","author":"G Rebeyrat","year":"2022","unstructured":"Rebeyrat G, Skalli W, Rachkidi R et al (2022) Assessment of dynamic balance during walking in patients with adult spinal deformity. Eur Spine J 31(7):1736\u20131744. https:\/\/doi.org\/10.1007\/s00586-022-07199-7","journal-title":"Eur Spine J"},{"issue":"1","key":"1347_CR23","doi-asserted-by":"publisher","DOI":"10.3390\/s25010017","volume":"25","author":"AM Ngueleu","year":"2024","unstructured":"Ngueleu AM, Barrette S, Buteau C et al (2024) Impact of pathway shape and length on the validity of the 6-Minute Walking Test: a systematic review and meta-analysis. Sensors 25(1):17. https:\/\/doi.org\/10.3390\/s25010017","journal-title":"Sensors"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01347-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-026-01347-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-026-01347-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:31:40Z","timestamp":1788870700000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-026-01347-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["1347"],"URL":"https:\/\/doi.org\/10.1007\/s43390-026-01347-5","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"assertion":[{"value":"30 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declared no potential conflicts of interest with respect to the research, authorship and\/or publication of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the National Medical Ethics Committee (Approval Number: 0120\u201322\/2023\/47). Additionally, the project was registered on ClinicalTrials.gov under the identifier NCT06557837.","order":2,"name":"Ethics","label":"Ethical approval and informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to their inclusion in the study.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}