What is spinal balance

Balance has been defined as the ability to maintain the center of gravity of a body within its base of support with minimal postural sway. From the point of view of the spine, it implies that, in both the frontal and sagittal planes, the head is positioned correctly over the sacrum and pelvis in both a translational and angular sense. Normal coronal plane balance is present when a plumb line dropped from the center of the C7 vertebral body lies within 1 cm of the middle of the sacrum. Normal sagittal plane balance is present when a plumb line dropped from the center of C7 lies within 2.5 cm of the posterior superior corner of S1. Another term for the plumb line measurement is the sagittal vertical axis (SVA). By convention, when the SVA falls behind the L5-S1 disc space, the SVA is considered negative. When the SVA falls through the L5-S1 disc, the SVA is considered neutral. When the SVA fall in front of the L5-S1 disc, the SVA is considered positive. In normal patients, the SVA is usually neutral or negative. In the normal patient, the SVA passes anterior to the thoracic spine, through the center of the L1 vertebral body, posterior to the lumbar spine, and through the posterior corner of S1.

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