Results At the time of the survey, the DSS consisted of 178 members: 107 orthopedic surgeons (60%), 61 neurosurgeons (34%) and 10 non-surgeon members (6%). Of those, 81 members declared not to perform spinal fusion operations and were therefore excluded from the survey. Of the remaining 87 orthopedic and neurosurgeons, 60 (68.9%) completed the survey (43 orthopedic surgeons (72%), 17 neurosurgeons (28%)). The main Research Article Abstract Purpose: To provide an overview of the influence of the

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... sagittal balance concept on diagnosis and decision making among spine surgeons in the Netherlands. Methods: A survey was conducted amongst members of the Dutch Spine Society, which includes both neurosurgeons and orthopedic surgeons. The survey posed questions concerning the application of the sagittal balance concept in clinical practice, diagnostic work-up, and its influence on decision-making and surgical outcome. Results: Among spine surgeons in the Netherlands, there is widespread support for the theory of the sagittal balance of the spine in clinical practice. Neurosurgeons apply it clinically less often and perform less diagnostics to determine the sagittal balance than orthopedic surgeons. When applied, for most respondents the sagittal balance concept influence clinical decision-making, but fewer think that it improves patients' outcomes. Conclusion: In the Netherlands, most spine surgeons are familiar with the theory of the sagittal balance, but its clinical application thus far is limited, especially amongst neurosurgeons.