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Juan I. Cirillo Totera Clínica Universidad de los Andes, Santiago, Chile
Hospital del Trabajador, Santiago, Chile

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José G. Fleiderman Valenzuela Clínica Universidad de los Andes, Santiago, Chile
Hospital del Trabajador, Santiago, Chile

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Jorge A. Garrido Arancibia Clínica Universidad de los Andes, Santiago, Chile

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Samuel T. Pantoja Contreras Clínica Universidad de los Andes, Santiago, Chile
Hospital Roberto del Río, Santiago, Chile

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Lyonel Beaulieu Lalanne Clínica Universidad de los Andes, Santiago, Chile

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Facundo L. Alvarez-Lemos Clínica Universidad de los Andes, Santiago, Chile

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”, “sagittal balance”, “sagittal imbalance”, “pelvic incidence” and “lumbar lordosis”. The inclusion criteria were articles, clinical guidelines, systematic reviews and randomized controlled trials (RCTs) published in indexed journals, with full

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Kamil Cagri Kose Marmara University Faculty of Medicine Department of Orthopedics and Traumatology, Istanbul, Turkey

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Omer Bozduman Ufuk University Faculty of Medicine Department of Orthopaedics and Traumatology, Ankara, Turkey

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Ali Erkan Yenigul Urfa State Hospital Department of Orthopedics and Traumatology, Istanbul, Turkey

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Servet Igrek Marmara University Faculty of Medicine Department of Orthopaedics and Traumatology, Istanbul, Turkey

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coronal and sagittal balance. The osteotomy sites are shown with black arrows. e) Intra-operative view of an asymmetric T10 pedicle subtraction osteotomy and instrumentation. Spinal cord and osteotomy site are shown with black arrows. SC, spinal cord; PSO

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George Grammatopoulos The Ottawa Hospital, Ottawa, Ontario, Canada

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Moritz Innmann Heidelberg University Hospital, Heidelberg, Germany

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Philippe Phan The Ottawa Hospital, Ottawa, Ontario, Canada

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Russell Bodner Midwest Orthopedic Institute, Sycamore, United States of America

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Geert Meermans Bravis Hospital, Roosendaal, The Netherlands

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plate (S1) to the center of the bicoxofemoral axis (midpoint between the femoral heads). This angle has also been termed as spinopelvic tilt (sPT or PT) in the hip literature. The sPT is the angle that best characterizes the sagittal balance between the

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Nick Evans University Hospital of Wales, Cardiff, UK

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Michael McCarthy University Hospital of Wales, Cardiff, UK

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classification that specifically considers the parameters that affect spino-pelvic sagittal balance in degenerative spondylolisthesis, and are the first to consider the therapeutic implications this may have. 47 Meanwhile, Simmonds et al have developed the

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Charles Rivière MSK Lab, Imperial College London, UK
South West London Elective Orthopaedic Centre, UK

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Stefan Lazic South West London Elective Orthopaedic Centre, UK

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Louis Dagneaux CHU de Montpellier, France

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Catherine Van Der Straeten London Hip Unit, UK

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Justin Cobb MSK Lab, Imperial College London, UK

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Sarah Muirhead-Allwood London Hip Unit, UK

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estimate the potential sagittal pelvic range of motion (ROM). 6 Definition of an individual’s sagittal balance through the assessment of these spino-pelvic parameters on standing spino-pelvic lateral images is best achieved with the EOS® imaging system

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Amer Sebaaly Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Maroun Rizkallah Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Falah Bachour Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Firas Atallah Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Pierre Emmanuel Moreau Department of Orthopedic Surgery, Centre Hospitalier Paris Saint Joseph, Paris, France

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Ghassan Maalouf Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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improved at six- and 12-month follow-up. 36 Results from these trials should be interpreted with caution since most of these studies are also sponsored by industry. 5 Sagittal balance of the spine has become an important concept in understanding

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Javier Pizones Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain

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Eduardo García-Rey Hip Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain

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patients with low back pain matched for age, sex, and size: a prospective controlled clinical study . Spine (Phila Pa 1976) 1994 ; 19 : 1611 – 1618 . 9. Barrey C Jund J Noseda O Roussouly P . Sagittal balance

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Francesco Benazzo Chirurgia Protesica ad Indirizzo Robotico, Fondazione Poliambulanza, Brescia, Italy

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Dante Dallari Reconstructive Orthopaedic Surgery and Innovative Techniques – Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Francesco Falez Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy

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Giuseppe Solarino Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, Bari, Italy

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Rocco D’Apolito Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Claudio Carlo Castelli FROM, Research Foundation Papa Giovanni XXIII Hospital, Bergamo, Italy

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(only recommendations), and the current low level of evidence (level 5, expert opinion). In their classification system, Phan et al . ( 19 ) used the PI–LL mismatch with PT as an index of spinal sagittal balance. A multicentre study showed that the

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Eduardo Moreira Pinto Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal

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Artur Teixeira Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal

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Ricardo Frada Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal

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Pedro Atilano Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal

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António Miranda Orthopaedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, Santa Maria da Feira, Portugal

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sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique . Eur Spine J 2018 ; 27 : 1981 – 1991 . 63. Umehara S Zindrick MR

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Anders Falk Brekke Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
University College Absalon, Center of Nutrition and Rehabilitation, Department of Physiotherapy, Region Zealand, Denmark

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Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Asbjørn Hróbjartsson Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Odense Patient data Explorative Network (OPEN), Odense, Denmark
Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark

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Anders Holsgaard-Larsen Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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research area and thus a lack of a meta-analysis, and the heterogeneity in study methods, populations and types of intervention. Clinical relevance Spinopelvic sagittal balance is described as an interrelation of muscle function, 22 , 33 and

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