Sagittal Alignment of the Lumbar Spine

Alignment of the lumbar spine has an important impact on the segmental motion, degenerative pathology, and health-related quality of life. The relationship between lumbar lordosis and pelvic incidence is predictive in the pathogenesis of spinal disorders, including disk degeneration, spondylolisthesis, and adjacent segment degeneration. This article reviews the relationship between lumbar and pelvic alignment with pathology of the lumbar spine, provides goals for appropriate alignment in reconstructive surgery, and discusses strategies for effective realignment of the spine.