Left Anterior Superior Iliac Spine Research Articles

Exploring 3D Pelvis Orientation: A Cross-Sectional Study in Athletes Engaged in Activities with and without Impact Loading and Non-Athletes.

Female athletes subjected to various types of impact loading, especially over a long period of time, may experience changes in their pelvic orientation, which may affect their sport performance and increase the likelihood of injury. The aim of the present study was to determine whether female athletes involved in high-impact loading sports (HILS), odd-impact loading sports (OILS), and repetitive non-impact loading sports (NILS) demonstrate changes in pelvis orientation compared to non-athletes (NATH). Pelvic orientation was determined using Euler/Cardan angles, calculated from the coordinates of the right, and left anterior superior iliac spines and pubic symphysis via a novel method. Two-way ANOVA tests showed significant differences between groups for pelvis position in the frontal plane (p < 0.05), with HILS and OILS demonstrating greater pelvic obliquity compared to NILS athletes and NATH. Significant main effects were also obtained for directions within the sagittal plane (p < 0.001). Significant within-group differences were observed in sagittal pelvic position among female athletes engaged in NILS (p < 0.01) and non-athletes (NATH) (p < 0.05), with a greater anterior pelvic tilt compared to posterior. Our findings suggest that pelvis orientation in female athletes across sports is influenced by sport-specific impact loads, potentially affecting performance and injury occurrence.

Pregnancy with Peripheral Arteriovenous Malformation

22 years old primigravida with 37 weeks singleton gestation was admitted with profuse bleeding from swelling over left anterior superior iliac spine region. Ultrasound findings suggested a high flow vascular malformation with feeder from left common femoral artery. Bleeding was managed conservatively with pressure bandage. Delivery was uneventful. Live female baby of 2.045 kg was delivered by spontaneous vaginal delivery at 38 weeks. After 4 weeks of delivery vascular malformation was confirmed with angiography and treated successfully with endovascular embolization of the major arterial feeder. In periodic follow up until 6 months, no further complication was reported by the patient.

A vital and disregarded anatomical landmark: Descending sigmoid colon flexure

Background: During the colonoscopy, colon tortuosity is a vital factor to complete the procedure successfully. Endoscopy can be difficult in cases with acute angle bending of adjacent colon segments. Aim: To assess the relationship of descending sigmoid colon flexure to vital anatomical points on CT in adult subjects. Methods: 114 adult subjects with CT examination of the abdominopelvic region were retrospectively analyzed. In 114 subjects, the angle between proximal sigmoid and descending colon was evaluated in degrees along with descending-sigmoid flexure position concerning the anterior aspect of the 5th lumbar vertebra, the median plane, and left anterior superior iliac spine. Results: Descending sigmoid flexure was seen in all 114 subjects. the LV-DSF was significantly higher in male subjects, with a distance of 123.7±23.1mm compared to female subjects where it was 115.6±21.2. This was statistically significant with p&lt;0.005. MP-DSF in male subjects was 97.8±15.6mm which was significantly higher than the female subjects having MP-DSF of 88.8±14.0mm. The minimum to maximum for males and females respectively were 52-149 and 44-116 which was a statistically significant difference with p&lt;0.001. However, for ASIS-DSF, the distance did not differ significantly between males and females with p=0.54 Conclusions.

Descending-sigmoid colon flexure – An important but surprisingly ignored landmark

BackgroundIn invasive examinations of the colon, e.g. colonoscopy, the tortuosity of the colon is a crucial factor for successful completion of the procedure. If adjacent segments of the colon bend at acute angles (under 90°), endoscopy may become difficult and troublesome. MethodsWe retrospectively enroled 227 individuals (96 female, 131 male) who underwent abdominopelvic computed tomography examination. For inclusion, subjects were required to have a negative history for colonic disease and abdominopelvic surgery. We measured the angle between the descending colon and the proximal part of the sigmoid (in degrees). In addition, the position of the descending-sigmoid flexure was assessed in relation to the left anterior superior iliac spine, the median plane, and anterior aspect of the 5th lumbar vertebra (in mm). The study protocol was reviewed and approved by the local ethics committee. ResultsWe visualised the descending-sigmoid flexure in all 227 subjects. In one third of cases, the flexure formed an angle smaller than/or 90°. In females, this landmark (mean ± standard deviation) was located 30.2 ± 8.4 mm from the left anterior superior iliac spine, 88.6 ± 14.2 mm from the median plane, and 115.4 ± 21.4 mm from the anterior aspect of the 5th lumbar vertebra. In males, the dimensions were: 32.1 ± 12.8 mm, 97.6 ± 15.8 mm, and 123.9 ± 22.9 mm, respectively. This landmark distance remained constant from the left anterior superior iliac spine regardless of subject age, height and weight. The other measured distances were related to age, height, weight or BMI. ConclusionsThe descending-sigmoid flexure is an important landmark in large intestine morphology situated approximately width of two fingers (3 cm) from the left anterior superior iliac spine and one hand width (9–10 cm) from the median plane. In approximately one third of the subjects, the flexure formed an angle of less than/or 90°, which can cause a problem during colonoscopy.

Anthropometric Determinations of Umbilical Position in Iraqi Adults.

Introduction Umbilicus is an important surface landmark on the anterior abdominal wall in addition to its aesthetic and psychological effect. Objectives The objective of the study is to determine the position of umbilicus in Iraqi adults to provide a guide for the neoumbilicus in abdominoplasty. Subjects and Methods This is an observational study performed on 100 volunteers with no abdominal wall abnormality. Measurements included weight, height, body mass index (BMI), distance from xiphoid to umbilicus, distance from xiphoid process to pubic symphysis, distance from xiphoid process to both anterior superior iliac spine (ASIS), distance from pubic symphysis to umbilicus and from pubic symphysis to xiphisternum, distance of umbilicus to both ASIS, and distance of umbilicus to interspinous line and to inter-anterior hypochondrium line. Results The study included 100 volunteers, with 50% male and 50% female whose age ranges between 18 to 60 years. The results were a follows: distance from xiphoid process to umbilicus and distance from xiphoid process to pubic symphysis were 18.03 ± 3.25 cm and 32.21 ± 4.64 cm, respectively; distances from xiphoid process to right ASIS and left ASIS were 25.95 ± 5.72 cm and 25.84 ± 6.02 cm, respectively; distance from pubic symphysis to umbilicus was 17.66 ± 3.12 cm; distance of umbilicus to interspinous line was 9.25 ± 1.84 cm. The distance from umbilicus to inter anterior hypochondrium line was 9.905 ± 2.19 cm. Conclusion These measurements can determine the neoumbilicus position, reduce practical mistakes, and improve postsurgical outcomes.

SUN-504 Association of Primary Hyperparathyroidism and Humoral Hypercalcemia of Malignancy in a Patient with Metastatic Endocervical Adenocarcinoma

Background: Paraneoplastic hypercalcemia is serious and commonly seen in a variety of malignancies. However its occurrence in gynecological malignancies is rare. We present a case of severe hypercalcemia due to the a rare occurrence of both parathyroid hormone (PTH) mediated and PTH-related protein (PTHrP) mediated hypercalcemia. Clinical Case: A 56-year-old female with a history of endocervical adenocarcinoma stage IVb metastatic to the peritoneum, lung, and bone and CKD stage III presented to the emergency department with symptoms of generalized pain, nausea and lethargy. Patient was diagnosed with endocervical adenocarcinoma 4 months prior to presentation and was treated with 2 cycles of chemotherapy (carboplatin/paclitaxel). At the time of diagnosis her total calcium was elevated at 11.9 mg/dL [8.9-10.4 mg/dL], however she did not have any further evaluation or treatment of the hypercalcemia. On presentation to the emergency department, total calcium was elevated at 17.3 mg/dL [8.9-10.4 mg/dL], albumin 3.0 g/dL [3.8-5.3 g/dL], creatinine 1.6 mg/dL [0.6-1.2 mg/dL], eGFR 35.8 mL/min/1.73m2, ionized calcium 2.85 [1.14-1.33], 25-hydroxy vitamin D 35 ng/mL [30-80 ng/mL], 1,25-dihydroxy vitamin D 24.8 pg/mL [19.9-79.3 pg/mL], PTH 401pg/mL [15-88 pg/mL] and PTH-related protein 65.3 pmol/L [0.0-3.4 pmol/L], Bone-specific alkaline phosphatase 58.1 U/L [14.2-42.7 U/L]. Patient was treated aggressively with intravenous fluids, calcitonin subcutaneously and pamidronate 60 mg intravenous infusion, given the depressed renal function. The total calcium level decreased to 10.9 mg/dL [8.9-10.4 mg/dL]. Nuclear medicine Tc-99m MDP whole body scan showed increased activity in the left proximal femur and left-sided pubic rami and questionable increased activity in the right iliac bone posteriorly and left anterior superior iliac spine. This was unchanged compared to a prior study done at the time of diagnosis. Immunohistochemical staining performed on the endocervical biopsy was negative for parathyroid hormone. Patient was discharged home with outpatient follow-up with oncology for zometa infusion however rapidly declined and passed away within 2 days. Conclusions: This is a rare case reporting concurrent PTH-dependent and PTH-related protein mediated pathways’ in a patient with advanced endocervical adenocarcinoma resulting is severe hypercalcemia. This case illustrates the importance of expanding differential diagnosis to consider disease states which require targeted therapy.

Relationship between Center of Pressure and Local Stability of the Lower Joints during Walking in the Elderly Women

Objective: The purpose of this study was to determine the relationship between center of pressure (CoP) and local stability of the lower joints, which was calculated based on approximate entropy (ApEn) during walking in elderly women. Method: Eighteen elderly women were recruited (age: <TEX>$66.4{\pm}1.2yrs$</TEX>; mass: <TEX>$55.4{\pm}8.3kg$</TEX>; height: <TEX>$1.56{\pm}0.04m$</TEX>) for this study. Before collecting data, reflective marker triads composed of 3 non-collinear spheres were attached to the lateral surface of the thigh and shank near the mid-segment to measure motion of the thigh and shank segments. To measure foot motion, reflective markers were placed on the shoe at the heel, head of the fifth metatarsal, and lateral malleolus, and were also placed on the right anterior-superior iliac spine, left anterior-superior iliac spine, and sacrum to observe pelvic motion. During treadmill walking, kinematic data were recorded using 6 infrared cameras (Oqus 300, Qualisys, Sweden) with a 100 Hz sampling frequency and kinetic data were collected from a treadmill (Instrumented Treadmill, Bertec, USA) for 20 strides. From kinematic data, 3D angles of the lower extremity's joint were calculated using Cardan technique and then ApEn were computed for their angles to evaluate local stability. Range of CoP was determined from the kinetic data. Pearson product-moment and Spearman rank correlation coefficient were applied to find relationship between CoP and ApEn. The level of significance was determined at p<.05. Results: There was a negative linear correlation between CoP and ApEn of hip joint adduction-abduction motion (p<.05), but ApEn of other joint motion did not affect the CoP. Conclusion: It was conjectured that ApEn, local stability index, for adduction/abduction of the hip joint during walking could be useful as a fall predictor.

Power Morcellation in the Bag: Surgical Technique and Clinical Applications

Introduction: Morcellation refers to the division of specimens into smaller pieces or fragments to facilitate the removal of tissue through small incisions during minimally invasive procedures. Most commonly it may be performed after laparoscopic hysterectomy (for enlarged uteri) or myomectomy. Recently, the use of power morcellation has been discouraged because of the risk of spreading an unsuspected uterine malignancy. In this video (run time 9:51), the authors demonstrate the surgical technique for laparoscopic power morcellation in the bag and some clinical applications of it. Patients and Methods: In our department, laparoscopic gynecologic procedures are performed using four trocars: one 10-mm umbilical trocar for the zero degree laparoscope and three 5-mm trocars for the instruments, one at the right iliac fossa, 2 cm medial to the right anterior superior iliac spine, another one at the left iliac fossa, 2 cm medial to the left anterior superior iliac spine, and the third one in the midline, 8 to 10 cm below the umbilical trocar. Whenever power morcellation is needed, the 5-mm trocar at the left iliac fossa is replaced by a 15-mm trocar for the morcellator at the end of the procedure, specifically for the step of morcellation. To perform the power morcellation within a bag, the authors use a large tissue retrieval bag (3100 mL). The bag is placed inside the abdominal cavity through the 15-mm trocar. The mouth of the bag is opened and the specimen to be morcellated is put inside the bag. The bag is closed pulling the draw string and it is retrieved from the abdominal cavity through the 15-mm trocar. This allowed for the externalization of the mouth of the bag through the skin incision. Then, the 15-mm trocar is replaced through the mouth of the bag. Pneumoperitoneum is insufflated through the 10-mm umbilical trocar. The assistant grabs the deeper part of the bag and pulls it out through the skin at the right iliac fossa. Finally, the surgeon grabs the closest portion of the bag to the umbilicus and externalizes it through the umbilical trocar. In this way, we have three different sites of the bag outside the abdominal cavity. The trocars are reinserted inside the bag. The insufflation pressure is increased from 12 mm Hg to 15 mm Hg and the insufflation is performed within the specimen bag. In this way, the specimen can be enclosed morcellated under direct visualization. Results: The procedure was effectively performed in four patients with different pathologies: (1) a 40-year-old woman with a 400 g uterus requiring total laparoscopic hysterectomy due to leiomyomas and abnormal uterine bleeding, (2) a 35-year-old woman undergoing laparoscopic myomectomy, (3) a 45-year-old woman undergoing subtotal laparoscopic hysterectomy for a 900 g uterus, and (4) a 49-year-old woman with a 65 mm solid ovarian mass (serous cystadenofibroma). In all patients, power morcellation could be performed safely within the bag. Conclusions: Power morcellation within a bag is a feasible technique. It may be an alternative way to preserve the benefits of minimally invasive surgery while mitigating the risks whenever specimen morcellation is necessary. No competing financial interests exist. Runtime of video: 9 mins 51 secs

Assessment of Pelvic Shape by a Newly Developed Posture Analyzer in Young Women in Japan

Background: Body composition has been changing along with change in the life style environment but there have been no studies on pelvic size by objective anthropometric assessment in young Japanese women. The objective was to examine pelvic shape by measuring the angle of inclination (AOI) and the distance between right and left anterior superior (AS) iliac spines. We also investigated associations of these measurements with physical symptoms related to distortion of the pelvis in young Japanese women. Methods: The AOI and the distance between right and left AS iliac spines in 92 female undergraduate students were measured by using a newly developed posture analyzer with a self-administered questionnaire. Results: The mean values of AOI and distance between right and left AS iliac spines were 0.31 radian and 270.1 mm, respectively. The distance between right and left AS iliac spines showed significant positive associations with body weight and height. According to tertiles of AOI, a large percentage of the subjects with a large AOI responded positively to the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”. According to tertiles of distance between right and left AS iliac spines, a large percentage of the subjects with a large distance responded positively to the item “Unhealed past injury in lower legs” and the item “Sitting with one’s legs folded sideways”. Conclusion: Increase in body weight and height were shown to be associated with pelvic shape. It has also shown that change in pelvic size can be estimated by the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”.

2F13 人工血管置換術用ナビゲーションにおける骨格の点を用いたレジストレーション法の開発と臨床データを用いた誤差評価

We have developed a navigation system for the blood vessel prosthesis replacement of aortic aneurysms, and have used it in clinical practice. This system supports surgeons to identify a target intercostal artery by using patient image. The patient image and real body are matched by registration. Reference points of registration are anatomical landmarks of skeleton such as jugular notch, sternal angle, left anterior superior iliac spine, pubis, and spinous process. However, identification of spinous process was hard to doctors in operation. We developed a new registration method which X, Y and Z axis correspond to the Head-Foot, Right-Left and Anterior-Posterior directions. The specific feature is that identification of spinous process is not necessary. We evaluated errors with the new registration method using the retrospective 6 clinical data. We calculated fiducial localization error. As a result, errors of anterior points in the Head-Foot direction were less than 10 mm. We aimed to reduce the Head-Foot error as less than 20 mm because the ribs exist at intervals of approximately 40 mm in the Head-Foot direction. The new registration method was confirmed to be effective in the decision of approach to the target artery. Moreover, even when the point of the spinous process changed to the next spinous process of the set spinous processes, error was equivalent to the original point, therefore, using the present system, the identification of the spinous process can be unnecessary. It was concluded that newly-developed registration algorism is effective for doctors in identification of intercostal artery.

Intense Splenic 99mTc-MDP Uptake in a Patient With Myelofibrosis

99mTc-MDP bone scan was performed in a 49-year-old woman with breast cancer. Whole-body bone scan showed multiple foci of increased MDP activity in the bone and intense splenic 99mTc-MDP uptake. Initial bone marrow aspiration in multiple locations yielded no blood cells. A subsequent bone marrow biopsy in the left anterior superior iliac spine showed myelofibrosis in addition to the known bone metastasis.

Plaster body wrap: effects on abdominal fat

BackgroundAbdominal fat is associated with metabolic disorders, leading to cardiovascular risk factors and numerous diseases. This study aimed to analyze the effect of plaster body wrap in combination with aerobic exercise on abdominal fat. MethodsNineteen female volunteers were randomly divided into intervention group (IG; n=10) performing aerobic exercise with plaster body wrap, and control group (CG; n=9) performing only exercise. Subcutaneous and visceral fat were measured using ultrasound; subcutaneous fat was also estimated on analysis of skinfolds and abdominal perimeters. ResultsAt the end of the 10-sessions protocol, the IG demonstrated a significant decrease (p ≤ 0.05) in subcutaneous fat at the left anterior superior iliac spine (ASIS) level and in iliac crest perimeter measurements. A large intervention effect size strength (0.80) was found in subcutaneous fat below the navel and a moderate effect size strength on the vertical abdominal skinfold (0.62) and the perimeter of the most prominent abdominal point (0.57). Comparing the initial and final data of each group, the IG showed a significant decrease in numerous variables including visceral and subcutaneous fat above and below the navel measured by ultrasound (p ≤ 0.05). ConclusionPlaster body wrap in combination with aerobic exercise seems to be effective for abdominal fat reduction.

Clay body wrap with microcurrent: Effects in central adiposity

IntroductionIncreased fat mass is becoming more prevalent in women and its accumulation in the abdominal region can lead to numerous health risks such as diabetes mellitus. The clay body wrap using compounds such as green clay, green tea and magnesium sulfate, in addition to microcurrent, may reduce abdominal fat mass and minimize or prevent numerous health problems. ObjectiveThis study aims at measuring the influence of the clay body wrap with microcurrent and aerobic exercise on abdominal fat. MethodsNineteen female patients, randomized into intervention (n=10) and control (n=9) groups, were evaluated using ultrasound for visceral and subcutaneous abdominal fat, calipers and abdominal region perimeter for subcutaneous fat and bioimpedance for weight, fat mass percentage and muscular mass. During 10 sessions (5weeks, twice a week) both groups performed aerobic exercise in a cycloergometer and a clay body wrap with microcurrent was applied to the intervention group. ResultsWhen comparing both groups after 5weeks of protocol, there was a significant decrease in the subcutaneous fat around left anterior superior iliac spine in the intervention group (ρ=0.026 for a confidence interval 95%). When comparing initial and final abdominal fat in the intervention group, measured by ultrasound (subcutaneous and visceral fat) and by skinfold (subcutaneous fat), we detected a significant abdominal fat reduction. ConclusionThis study demonstrated that the clay body wrap used with microcurrent and aerobic exercise can have a positive effect on central fat reduction.

PROXIMAL SARTORIUS TENDON RUPTURE AS A CAUSE OF TRAUMATIC ANTERIOR HIP PAIN-A CASE REPORT OF A PROFESSIONAL FOOTBALLER

BackgroundSartorius injuries are seldom mentioned in medical literature. Thus developing an evidence-based management plan for sartorius muscle and tendon injuries can be challenging. In this case a grade 3 tear...

English

English

A Single-Dose Conformal Delivery of Radiotherapy Following Osteoplasty

Multiple myeloma (MM) is a very radiosensitive tumor. Fractionated external beam radiation, which takes approximately 2 weeks of therapy, is typically used to irradiate myelomatous bone lesions with the goal of palliation. However, traditional radiotherapeutic techniques are not only lengthy but they also involve a considerable amount of healthy bone marrow in the treatment ports, which may undermine the total marrow reserve of a patient. Because of the limited survival time of patients with metastatic cancer, novel treatment concepts shortening the overall treatment time is desirable. We present an innovative approach of delivering targeted intra-operative radiotherapy to a solitary osteolytic metastasis in one application, while sparing healthy bone marrow from radiation toxicity and substantially reducing the overall treatment time. A 78-year-old Caucasian male with MM, previously treated with chemotherapy, who was off chemotherapy for 2 years due to bone marrow suppression, presented with a solitary recurrence at the left anterior superior iliac spine of the left iliac wing as diagnosed by PET-CT scan. This lesion was treated with a minimally invasive osteoplasty and intra-operative brachytherapy with to a dose of 8 Gy delivered to the surgical cavity only, followed by injection of the bone cement into the cavity. Three months after the procedure, the area of treatment demonstrated no uptake on a follow-up PET-CT scan. At 1.5 years after this procedure, 100% local control continues to persist in the treated area, as evidenced on nuclear imaging. To our knowledge, this is the first case of using focal intra-operative brachytherapy confined to the area of the pelvis in a patient treated for a solitary metastasis from MM. The purpose of the article is to present a novel approach as a more convenient and focal treatment of bony lesions of MM.

Psoas Abscess Caused by Spontaneous Rupture of Colon Cancer

Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.

Transcatheter coil embolization of the inferior epigastric artery in a huge abdominal wall hematoma caused by paracentesis in a patient with liver cirrhosis

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.

Anterior superior iliac spine avulsion in a young soccer player

Avulsion fractures of the anterior superior iliac spine are rare. They usually occur in teenagers during sport activities. Cases concerning adults are very uncommon. We report here the case of a 23-year-old man who was admitted for recent pain of the left hip that worsened while kicking a ball in a soccer match eight days earlier. The examination found pain when moving the left hip in extension. Radiographs showed an avulsion fracture of the left anterior superior iliac spine, which was confirmed by computer tomography. The treatment was conservative consisting in rest and non-weight bearing with releasing of pain a few weeks later.

Which Lateral Radiographic Positioning Technique Provides the Most Reliable and Functional Representation of a Patient’s Sagittal Balance?

Prospective nonscoliotic cohort evaluation of the effects of various positions for obtaining standing lateral thoracolumbar radiographs. The purpose of this study was to compare the effects of various upper extremity positions on thoracolumbar sagittal spinal alignment. The standing position used to capture a lateral plane radiograph can have marked effects on measurements of sagittal spinal alignment and may compound the variability between measurements from successive radiographs. Twenty-two healthy female adolescents performed 3 repeated trials of 4 standing positions in a motion analysis laboratory. The positions included: (1) relaxed standing with arms at sides (CONTROL), (2) standing with fists overlying ipsilateral clavicles (CLAVICLE), (3) active shoulder flexion to 30 degrees with elbows extended (30 ACTIVE), and (4) passive shoulder flexion to 30 degrees with hand supports (30 PASSIVE). Sagittal alignment of the spine was described by kyphosis, lordosis, and the sagittal vertical axis (SVA), all of which were measured from the positions of reflective markers attached to the surface of the back and pelvis. Differences between alignment measures obtained for each of the 3 radiographic positions relative to the functional position (CONTROL) were calculated. Mean differences were then compared between positions using repeated measures ANOVAs (alpha = 0.05). Relative to the CONTROL position, all other positions resulted in negative shifts in SVA (range = -1.1 cm- -4.6 cm), decreased kyphosis (range = -1 degrees- -3 degrees), and increased lordosis (4 degrees for all positions). The shift in the SVA with the 30 PASSIVE position was significantly less than the other 2 positions (P < 0.05) and demonstrated the least variability. Standing with the hands supported while flexing the shoulders 30 degrees during positioning for lateral spinopelvic radiographic acquisition resulted in an SVA and measures of sagittal plane curvature that were comparable with a functional standing position with arms at the side. This seems to be the best way to move the arms anterior to the spine with the least effect on overall sagittal balance.