Describe the normal sagittal contour of the adult spine

In the sagittal plane, the normal spine possesses four balanced curves (Fig. 53-1). The kyphotic thoracic and sacral regions are balanced by the lordotic cervical and lumbar regions. In the normal state, the sagittal vertical axis (determined by dropping plumb line from the center of the C7 vertebral body) passes anterior to the thoracic spine, through the center of the L1 vertebral body, posterior to the lumbar spine, and through the lumbosacral disc. A positive sagittal vertical axis (SVA) is present when this line passes in front of the anterior aspect of S1. Negative SVA is present when this line passes behind the posterior aspect of S1. Sagittal imbalance has been defined as an SVA passing more than 5 cm anterior to the posterior margin of the superior S1 endplate.

Figure 53-1. Normal sagittal alignment of the spinal column. Note the sagittal vertical axis line and the orientation of each individual vertebrae. (From DeWald RL. Revision surgery for spinal deformity. Instructional Course Lectures vol. 41. Park Ride, IL: American Academy of Orthopaedic Surgeons; 1992.)

Figure 53-1. Normal sagittal alignment of the spinal column. Note the sagittal vertical axis line and the orientation of each individual vertebrae. (From DeWald RL. Revision surgery for spinal deformity. Instructional Course Lectures vol. 41. Park Ride, IL: American Academy of Orthopaedic Surgeons; 1992.)

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