Sagittal Imbalance: Symptoms, Treatment


A sagittal imbalance is a kind of spinal deformity that includes a significant component of forwarding postural instability. It causes a front-to-back imbalance in the spine.

In general, the spine has two gentle front-to-back curves. The lower spine has an inward curve called lordosis. The middle spine has an outward curve called kyphosis. These two curves work together to keep the body’s center of gravity along with the hips and pelvis. Nevertheless, if one of these curves gets too pronounced or too flat, the spine will become imbalanced from back-to-front, which will lead to sagittal imbalance.


Sagittal imbalance normally results from a loss of harmony between normal regional contours of the spine. This deformity can gradually occur over time with age but can also be associated with previous spinal fusion surgery. Some other risk factors include:

  • Lumbar fusion, a procedure that removes a joint from the spine and fuses two (or more) vertebrae together
  • Lumbar stenosis, the narrowing of passages of the spinal cord and nerves
  • Degenerative conditions, like degenerative disc disease, which is often caused by wear and tear on the spine
  • Kyphosis, excessive forward curvature in the spine
  • Osteoporosis, a condition of weak and brittle bones
  • Ankylosing spondylitis, a type of arthritis
  • Neuromuscular conditions, such as spina bifida, cerebral palsy, or muscular dystrophy


Sagittal imbalance results in the forward displacement of the head relative to the sacrum and pelvis. Common signs and symptoms of sagittal imbalance include:

  • Lower back pain
  • Difficulty in walking
  • Incapable of continually looking straight ahead when standing
  • Chronic pain
  • Fatigue
  • Difficulty with mobility
  • Constantly leaning forward

Besides, a sagittal imbalance may be attributed to something that stresses on spinal nerves, which may cause pain, numbness or weakness. Some cases of sagittal imbalance may even get worse over time. Severely, it can lead to difficulties in breathing.


To determine the degree of sagittal imbalance, the doctor may conduct an X-ray to check the general situation of your spine. Besides, the doctor may also take extra diagnostic tests to get more detailed images of the spine, including:

  • Magnetic resonance imaging (MRI) scan

It uses a magnet and radio waves to provide detailed images of the spinal cord. It shows soft tissues (discs, spinal cord, and nerves) clearly. This scan can help figure out whether the spinal cord has been affected by the spinal curvature.

  • Computed tomography (CT) scan

It uses X-rays and a computer to produce detailed images of the spine bones and surrounding structures. CT scans show more detailed pictures than general X-rays.


Since there are various causes of sagittal balance, patients are supposed to adopt to different treatments. The overall goal of these treatments of Sagittal balance is to reestablish sagittal spinal balance.

When surgery is needed, it usually aims to add lordosis to the lumbar spine, take away kyphosis from the thoracic spine, or both. The purpose of surgery is to restore erect posture, which will further enable the patient to walk upright, normalize appearance, rebuild self-esteem and confidence, and generally enbale them to live a normal everyday life. The operative treatment of sagittal imbalance is complex and possibly accompanied by some complications.

Nonoperative or operative treatment must be planned to address all facets of the deformity adequately, at the same time reducing the possibility of unexpectable events or an unsatisfactory outcome. The surgery generally consists of three major parts:

  1. Correct the spinal deformity
  2. Spinal fixation
  3. Spinal fusion

In addition, patients can also take some exercises to help relieve the symptoms and compensate for the loss of curvature to some degree. Right exercises can offer you more strength in your spine and help you gradually stand up straighter. Exercises that focus on erector muscles, the bundle of muscles and tendons that run parallel to the spine, are good for patients. To help strengthen these muscles, try doing the following:

  • Lay down on your stomach on a flat surface (a bed or floor) and bring both your hands to your lower back and slowly lift your chest off the floor as high as you possible
  • Perform repetitive “rowing” motions on a rowing machine
  • Take a forward-flex posture in your back

It’s advisable to check with your doctor to make sure that the activities you choose are appropriate for your personal condition before you start any kind of exercises.

Keywords: sagittal imbalance.

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.