How reproducible do we stand and sit? Indications for a reliable sagittal spinal assessment

Background: Currently, an upright standing posture is normally adopted for evaluations of spinal alignment, which is however sensitive to posture variations. Thus, finding a reproducible reference is essential. This study aimed to evaluate the reproducibility of standing and sitting postures at different arm positions in five consecutive repetitions. Methods: 22 asymptomatic subjects (11 males; 11 females) aged 20-35 years were included. Subjects were repeatedly asked to adopt different arm positions in standing and sitting. The absolute reposition errors of lumbar lordosis and sacral orientation between two consecutive repetitions were assessed with a non-radiological back measurement system. Findings: During standing at the relaxed arm position, the median absolute reposition errors of lumbar lordosis and sacral orientation were 1.14 degrees (range 0.23 degrees-3.80 degrees) and 0.92 degrees (range 0.17 degrees-3.27 degrees), respectively, which increased to 1.75 degrees (range 0.21-4.97 degrees) and 1.36 degrees (range 0.35 degrees-4.08 degrees) during sitting (P < 0.01). The absolute reposition error of lumbar lordosis was non-significantly lower at the relaxed and clasped arm positions than at other arm positions. Between the first two repetitions, the absolute reposition errors of both, lumbar lordosis and sacral orientation, were greater than between the remaining two consecutive repetitions (P < 0.01). Both during standing and sitting, lumbar lordosis was smallest when hands holding two bars (P < 0.05). Interpretation: Sitting showed a worse reproducibility than standing. When assessing sagittal spinal balance, the clasped arm position during standing is recommended and an initial trial can help to reduce inception irreproducibility.