What is Normal Spinal Alignment ?


A Multi-Ethnic Alignment Normative Study (MEANS)

We have had the privilege of collaborating with multiple international sites to establish a cohort of asymptomatic volunteers (468) with no prior spinal pathology. This was done to develop a more detailed understanding of spinal alignment. We have to understand normal to identify abnormal !

I am proud to share that we now have several publications addressing this topic and I will try to share some key points in upcoming posts.

Key Points:

  • Thoracic Kyphosis does NOT correlate with PI
  • Lumbar lordosis is better predicted if we use PI AND thoracic kyphosis – PI alone is only partly useful.
  • Age accounts for minimal decrease in Lumbar lordosis in asymptomatic people
  • Thoracic kyphosis increases with age
  • Cervical lordosis increases with age to compensate for increasing thoracic kyphosis. Therefore, Cervical SVA (C2-C7 SVA) is maintained with age
  • Slight cervical kyphosis in young people is NORMAL
    cervical alignment is dependant on throacic alilgnment: CL=−24.5+1.1 (T1slope)

Key results:
Cervical lordosis from C2 to C7: −0.4±12.7°
T1-slope: 23.0±7.9°
Thoracic kyphosis (TK) from T4 to T12: 37.4±10.9°
L1–S1 lumbar lordosis (LL): −57.4±11.3°
Pelvic incidence (PI): 52.0±10.7°
Pelvic tilt (PT): 12.5±7.3°
PI-LL mismatch: −5.4±10.7°
Cervical sagittal vertical axis (cSVA): 19.0±9.8 mm

Age based equations for predicting LL which I use routinely now:
Age 18-28: LL=8.6+0.55(PI)+0.61(TK); r2=0.77
Age 29-37: LL=5.8+0.62(PI)+0.57(TK); r2=0.75
Age 38-50: LL=5.9+0.57(PI)+0.58(TK); r2=0.78
Age 51-64: LL=8.6+0.56(PI)+0.46(TK); r2=0.69
Age > 64: LL=4.0+0.51(PI)+0.53(TK); r2=0.66

Regarding PI-LL mismatch:
60% of volunteers met the PI-LL criteria within ±10°
PI-LL mismatch of ≥10° in only 8.3%
LL was higher than PI by ≥10° in 32.1%

#neurosurgery #physicaltherapy #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers

https://journals.lww.com/spinejournal/fulltext/2022/10010/age_and_gender_based_spinopelvic_and_regional.6.aspx

Navigating Airport Security with Spinal Implants

Attention to those with spinal fusion implants or considering scoliosis surgery! You may be detected by metal detectors at the airport. Ease your travel by filling out the TSA notification card and present it to the agents. Opting for the Advanced Imaging Technology (AIT) machine is often a smoother choice instead of the walk-through metal detector

Click the TSA notification card and take control of your travel experience today. Share with those who may benefit.

About the Author

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C is Co-Chief of Spinal Deformity Surgery, Director of Quality & Patient Safety, and Medical Director of the Spine Unit at Och Spine Hospital, NewYork-Presbyterian / Columbia University. Board-certified in orthopaedic surgery, he completed three spine fellowships — combined orthopedic and neurosurgical spine (Cedars-Sinai), artificial disc replacement (Texas Back Institute), and complex spinal deformity (Columbia) — and specializes in scoliosis, kyphosis, complex revision and Harrington rod revision surgery, and motion-preserving and robotic-assisted spine surgery. He is a member of the Scoliosis Research Society. Read full bio →

Untreated Scoliosis: Consequences of Delay in Detection or Treatment

Parents and teens: Untreated scoliosis can lead to severe curve progression, chronic pain, limited mobility, and in extreme cases can affect lung function. Early detection and appropriate treatment are vital.

The X-rays below are from a patient in her early 40s whose scoliosis went unnoticed and untreated through adolescence. She is now facing a significantly larger and more complex surgical correction than she would have needed if treated at the right time.

Standing X-ray showing severe untreated adult scoliosis

Early treatment as a child or teenager could have avoided the significantly more complex surgery she now requires. Sharing this case to help spread awareness of the importance of timely scoliosis evaluation and care.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in scoliosis in adolescents and adults, including complex late-presenting and revision cases. To schedule a consultation, call 212-932-5187 or visit the contact page.

X-rays shared for educational purposes with patient’s consent. This post does not constitute individualized medical advice.

Scoliosis Screening with a Scoliometer: Your Pediatrician’s Powerful Tool

Hello, teens and parents! Today, let’s dive into how your pediatrician or primary care physician can use a scoliometer to screen for scoliosis. This simple yet effective tool is a game-changer in ensuring early detection and optimal spine health.

What is a Scoliometer?

A scoliometer is a device that your pediatrician might use during a routine checkup to measure the rotation of your back. It helps them identify potential signs of scoliosis at an early stage.

The Screening Process

The pediatrician will have your teen stand with their feet together and slowly bend forward to touch their toes. They will gently place the scoliometer on their back’s highest point and measure the degree of rotation.

If the scoliometer reading is higher than 5–7 degrees, further evaluation by a spine specialist, such as an orthopedic surgeon, is necessary. The specialist may conduct a more comprehensive examination, which may include X-rays or other imaging tests, to confirm the presence and severity of scoliosis.

Raising awareness about scoliosis screening with scoliometers helps more families catch this early. Share this post to empower others with knowledge, and thank your pediatrician for supporting your spine health.

About the Author

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C is Co-Chief of Spinal Deformity Surgery, Director of Quality & Patient Safety, and Medical Director of the Spine Unit at Och Spine Hospital, NewYork-Presbyterian / Columbia University. Board-certified in orthopaedic surgery, he completed three spine fellowships — combined orthopedic and neurosurgical spine (Cedars-Sinai), artificial disc replacement (Texas Back Institute), and complex spinal deformity (Columbia) — and specializes in scoliosis, kyphosis, complex revision and Harrington rod revision surgery, and motion-preserving and robotic-assisted spine surgery. He is a member of the Scoliosis Research Society. Read full bio →

Straighten Up: Easy Ways to Check for Scoliosis at Home

For parents of children between the ages of 10 and 18, it is worth knowing some simple ways to screen for scoliosis at home. These are not a substitute for a professional evaluation, but they can help identify changes that warrant a check-up.

Three Simple Home Screening Steps

  1. The Adams Forward Bend Test. Have your child stand with feet together and slowly bend forward to touch their toes, arms hanging freely. Observe the back from behind and from the side. A visible rib hump, shoulder blade prominence, or one side of the back appearing higher than the other when bending forward may indicate a spinal curve worth evaluating.
  2. Shoulder and waistline symmetry. Ask your child to stand relaxed with arms at their sides. Check whether one shoulder blade appears higher than the other, or whether the waistline looks uneven from side to side. These asymmetries can be subtle in early scoliosis.
  3. Observe standing posture. A tendency to lean consistently to one side, or an uneven hip line, may be worth noting. Postural changes that are new or progressive deserve a professional evaluation.

When to Seek Evaluation

If you notice any of the above signs, do not panic — the large majority of adolescent curves are mild and do not require surgery. What matters is getting an early, accurate evaluation while treatment options are at their broadest. A pediatrician, school nurse, or spine specialist can perform a more thorough screening and order standing X-rays if indicated.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in scoliosis in adolescents and adults. Early evaluation leads to better outcomes. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your child’s specific situation.

Demystifying Scoliosis: Q&A Part 2

Continuing to address common questions about scoliosis for patients, parents, and families:

  • What causes scoliosis? Scoliosis can have various causes. Adolescent idiopathic scoliosis — the most common form — has no identified single cause. Other forms are congenital (from vertebral malformations present at birth) or neuromuscular (associated with conditions like cerebral palsy or muscular dystrophy).
  • Is scoliosis noticeable? It depends on the severity. Mild curves often produce no visible change. Larger curves may cause uneven shoulder height, a prominent shoulder blade, an uneven waistline, or a rib hump visible when bending forward.
  • Can scoliosis be prevented? Scoliosis cannot be prevented, but early detection significantly improves treatment options and outcomes. Screening during adolescent growth is important precisely because it identifies curves while they are still manageable.
  • How is scoliosis diagnosed? Diagnosis involves a clinical examination — including the Adams forward bend test — and standing X-rays to measure the Cobb angle. The Cobb angle is the standard way to quantify how much the spine curves.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in scoliosis in adolescents and adults, kyphosis, and complex spinal deformity. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.

Navigating Scoliosis Together

As a scoliosis surgeon, I frequently engage with adolescents and their parents who are navigating a new scoliosis diagnosis. Here are answers to some of the most common questions I hear:

  • What is scoliosis? A condition that leads to a sideways curvature of the spine of 10 degrees or more on X-ray.
  • Can it be inherited? Scoliosis can manifest in various forms, some of which may be influenced by genetics — though most adolescent idiopathic scoliosis has no clear single cause.
  • Is pain always associated with scoliosis? Not necessarily. Adolescent idiopathic scoliosis is typically painless; pain in a young patient with a curve should prompt additional evaluation.
  • Will it prevent me from leading an active life? Most people with scoliosis can participate fully in physical activities, especially with a tailored treatment plan.

Every patient’s journey with scoliosis is unique. Seek specialist evaluation for personalized information and treatment options.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in scoliosis, kyphosis, and complex spinal deformity in adolescents and adults. To schedule a consultation, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.

The impact of scoliosis on health in adult patients

A landmark study published in Spine highlights the debilitating impact of scoliosis and spinal deformity on the health and quality of life of adult patients. Patients with scoliosis of the lower back and forward-stooped posture (sagittal malalignment) were found to be more disabled — by validated health-related quality of life measures — than patients with significant limitations of arms and legs.

This finding underscores why adult spinal deformity deserves to be taken as seriously as other major musculoskeletal conditions. Patients who are told to “live with it” or that surgery is too risky deserve an honest, expert assessment of what is actually possible — and what the trajectory of their condition looks like without intervention.

Reference: Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682–688. PMID 15770185

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in adult and adolescent scoliosis, spinal deformity, and complex revision surgery. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.

This post is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.