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. 2018 Jan 10;18:8. doi: 10.1186/s12876-018-0738-6

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© The Author(s). 2018

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Fig. 1 — Representative cases with or without severe gastroesophageal reflux disease symptoms: Frequency Scale for Symptoms of GERD score of 2 (a) or 23 (b). The white line denotes lumbar lordosis. The yellow line denotes thoracic lumbar kyphosis

a Lateral standing radiograph showing global sagittal malalignment due to a − 11° lumbar lordosis and a 51° thoracic lumbar kyphosis. Lateral radiograph obtained in the fulcrum backward-bending position showing thoracic lumbar kyphosis reduced to 15°. b Lateral standing radiograph showing a − 20° lumbar lordosis and global sagittal malalignment due to a 51° thoracic lumbar kyphosis. Lateral radiograph obtained in the fulcrum backward-bending position showing a 41° thoracic lumbar kyphosis that is not flexible.