Low back pain is one of the most common symptoms in adults with spinal imbalance. Sagittal imbalance may be seen together with low back pain. Alignment disorders of the sagittal plane are widely seen as the increasing cause of pain and disabilities. It has been shown that the existence of adult spine deformity in patients with sagittal balance is the most important and reliable radiologic indicator for the health related quality of life. Global alignment, regional and pelvic parameters should be considered together with radiologic examinations. In radiological evaluation of sagittal plane deformities accompanied with low back pain, one should measure lumbar lordosis, sagittal vertical axis, pelvic incidence, sacral slope and pelvic tilt. In patients with low back pain having adult spinal deformity, changes in sagittal plane, as well as coronal plane deformity should be evaluated by using Scoliosis Research Society - Schwab classification system. Deficiency in sagittal plane alignment may result in pain, deformity, and low quality of life related to health of the patient. It has been shown that a positive imbalance in sagittal plane caused a decrease in health related quality of life, whereas the postoperative correction of sagittal plane deformities showed a significant improvement. In accordance with these results, sagittal imbalance in patients with low back pain and health related quality of life scores should be noted for the evaluation and planning of the treatment.