Sagittal Imbalance
What is sagittal imbalance?
Sagittal imbalance refers to a condition where there is abnormality in the normal alignment of the spine in the front-to-back or sagittal plane, i.e. when viewed from the side. The normal spine is designed to have sagittal plane curves: lordosis (arch backward) in the cervical and lumbar regions and kyphosis (arch forward) in the thoracic region. Sagittal imbalance occurs when these curves are abnormal, leading to a misalignment that affects posture and can cause pain and functional impairment.
The origin of all spinal alignment is the sacrum, a bone at the base of the spine. The human sacrum acts as the keystone which connects the spine to the pelvis. This bone is typically “set” in the pelvis, and the angle at which it is set determines how much lumbar lordosis or “arch” is required for the patient to stand up straight. When not enough arch is present due to degeneration, trauma, prior surgery, or other causes, patients may have difficulty standing up straight and may attempt to compensate in other areas of the spine, leading to fatigue, pain, and disability.
- Back pain
- Difficultly standing upright
- Fatigue in the back or legs from the added effort required to maintain balance
- Decreased mobility
- Visible posture changes such as a forward leaning stance
- Neurological Symptoms when a nerve is compressed, including numbness, tingling, or weakness in the legs.
Several factors can contribute to sagittal imbalance, including:
- Conditions like degenerative disc disease, spinal stenosis, and spondylolisthesis can alter spinal alignment.
- Injuries to the spine, such as fractures, can disrupt normal alignment.
- Previous spinal surgeries, particularly those that involve fusion, can sometimes lead to imbalance.
- Birth defects affecting spinal alignment, such as scoliosis, can cause sagittal imbalance.
- Osteoporosis weakens the bones, leading to vertebral compression fractures and malalignment.
- Weakness in the muscles supporting the spine can contribute to poor posture and imbalance.
Diagnosing sagittal imbalance typically involves a comprehensive evaluation. Dr. Colman will review your medical history and perform a physical examination to assess symptoms and postural abnormalities. He will order imaging studies including full length standing X-rays to assess the degree of imbalance and curvature abnormalities. Advanced imaging like an MRI or CT scan can be helpful to evaluate underlying conditions, such as disc degeneration or spinal stenosis, and to assess soft tissue structures. He will also take specific measurements such as the sagittal vertical axis (SVA), pelvic tilt, and lumbar lordosis, in order to quantify the extent of imbalance.
The treatment of sagittal imbalance aims to relieve symptoms, improve posture, and restore spinal alignment. Treatment options include:
Conservative Management
- Physical Therapy: Exercises to strengthen the core and back muscles, improve flexibility, and enhance posture.
- Pain Management: Medications, such as NSAIDs or muscle relaxants, and injections like epidural steroid injections to manage pain and inflammation.
- Bracing: In some cases, spinal braces may be used to provide support and improve alignment.
- Lifestyle modifications: Recommendations may include weight management, ergonomic adjustments, and activity modifications to support spinal health.
Surgical intervention
Surgical intervention may be necessary for severe cases and when conservative treatments fail. Surgical options include:
- Spinal fusion to correct alignment and stabilize the spine
- Osteotomy: the cutting and realigning of the bones to correct deformities
- Decompression surgery to relieve pressure on the spinal nerves
Sagittal imbalance is a complex condition impacting the spine’s natural curvature and alignment, resulting in symptoms such as pain and functional limitations. When you or a loved one has back pain it is important to get the correct diagnosis and all your treatment options. Contact Dr. Matthew Colman at Northwestern Medicine in Chicago, Illinois to schedule a consultation. He specializes in degenerative spine conditions, spine trauma, spinal deformities and spine oncology. His patients find him to be a kind, caring, and thorough surgeon, who has a wonderful bedside manner, and is knowledgeable and trustworthy. They note that he takes time to listen to his patients, answers their questions and explains conditions so that you have complete information to make informed decisions about your orthopedic care. Schedule a consultation today.
At a Glance
Dr. Matthew Colman
- Internationally recognized expertise and thought leadership for a diverse range of spinal problems
- Patient-specific and humanistic approach which uses the latest technology and techniques
- Team centered approach prioritizes availability, communication, and support
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