Spinal Posture and Pathology in Modern Humans

Ella Been, Azaria Simonovich, Leonid Kalichman

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

3 Scopus citations


Humans are the only living hominoid that habitually stands upright and walks on two legs. The adoption of erect posture as habitual imposed substantial changes on spinal morphology and biomechanics. One of the major morphological changes is the increased curvatures found in the human spine. There is an ongoing debate about whether humans “pay” for becoming bipedal by suffering from a high prevalence of back pain and spinal pathology. In order to answer this question, we explored the relationship between sagittal spinal posture and spinal pathologies, back pain, and health-related quality of life. We found that spinal posture closely correlates with spinal pathology. Individuals with a well-aligned spine-within the neutral zone defined as moderate spinal curvatures and the line of gravity close to the acetabulum-have a better quality of life, less back pain, and less spinal pathology. Individuals out of the neutral zone, with accentuated or with decreased pelvic incidence and spinal curvatures, are at a higher risk for developing spinal pathology, back pain, and reduced quality of life. All of this indicates that adopting an erect posture and bipedalism has an impact on human’s spinal health because variation in curvatures outside the neutral zone is associated with more spinal pathology, back pain, and lower quality of life, than those within this zone.

Original languageEnglish
Title of host publicationSpinal Evolution
Subtitle of host publicationMorphology, Function, and Pathology of the Spine in Hominoid Evolution
EditorsElla Been, Asier Gómez-Olivencia, Patricia Ann Kramer
PublisherSpringer International Publishing
Number of pages20
ISBN (Electronic)9783030193492
ISBN (Print)9783030193485, 9783030193515
StatePublished - 1 Jan 2019


  • Disc degeneration and herniation
  • Evolution
  • Neutral zone
  • Spondylolysis and spondylolisthesis

ASJC Scopus subject areas

  • General Agricultural and Biological Sciences
  • General Social Sciences
  • General Biochemistry, Genetics and Molecular Biology


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