Reviewer’s comment concerning “Spinous process morphology: the effect of ageing through adulthood on spinous process size and relationship to sagittal alignment” (doi:10.1007/s00586-011-2029-6 by C.E.W. Aylott, R. Puna, P.A. Robertson, C. Walker)

I think, that interesting is not so much the implication for surgical techniques, but rather the question of “growth” of LSP as a consequence or the reason of delordosation. Is the enlargement exclusively due to a primary degenerative process (or enthesopathies), which might influence the creation of a spinal malalignment or is it due to an increase of bone mass (common growth process) of the LSP, which has certain similarities to the Wolf’s Law and might hence deliver the reason for the enlargement of LSP; that means in turn that the reduced lordosis is the primary cause? But I warn to attach the problem of delordosation one-sided only with the growth of LSP without considering the relation between increased thoracic kyphosis and decreased lordosis in the elderly (body posture), to leave the bone mineralization out of account or without keeping the loss of lumbar extensor strength (muscle weakness), ligamentous attrition, disc degeneration and loss of anterior column height in mind (I remind of the degenerative scoliosis of the elderly).