{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:53:19Z","timestamp":1782463999075,"version":"3.54.5"},"reference-count":108,"publisher":"ASME International","issue":"7","content-domain":{"domain":["asmedigitalcollection.asme.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:p>In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and\/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities\u2014ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections\u2014pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.<\/jats:p>","DOI":"10.1115\/1.4043650","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T17:55:54Z","timestamp":1556819754000},"update-policy":"https:\/\/doi.org\/10.1115\/crossmarkpolicy-asme","source":"Crossref","is-referenced-by-count":39,"title":["Spinal Balance\/Alignment\u2014Clinical Relevance and Biomechanics"],"prefix":"10.1115","volume":"141","author":[{"given":"Anoli","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Bioengineering, Engineering Center for Orthopaedic Research Excellence (E-CORE), Colleges of Engineering and Medicine, University of Toledo, 2801 W. Bancroft Street, MS 303, NI Hall, Toledo, OH 43606"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin V. C.","family":"Lemans","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 cx, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Zavatsky","sequence":"additional","affiliation":[{"name":"Spine and Scoliosis Specialists, 10908 Ridgedale Road, Tampa, FL 33627"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakash","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Engineering Center for Orthopaedic Research Excellence (E-CORE), Colleges of Engineering and Medicine, University of Toledo, 2801 W. Bancroft Street, MS 303, NI Hall, Toledo, OH 43606"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moyo C.","family":"Kruyt","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 cx, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Serhan","sequence":"additional","affiliation":[{"name":"Depuy Synthes Spine Inc., 325 Paramount Dr, Raynham, MA 02767"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Engineering Center for Orthopaedic Research Excellence (E-CORE), Colleges of Engineering and Medicine, University of Toledo, 2801 W. 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