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Alignment Goals in Adult Spinal Deformity Surgery.
Javier Pizones1, Jeffrey Hills2, Michael P Kelly3
1Spine Surgery Unit, La Paz University Hospital, Madrid, Spain.
Global Spine Journal
|July 9, 2025
Summary
Adult spinal deformity surgery now focuses on individual alignment goals to prevent complications. While traditional metrics are insufficient, restoring ideal spinal shape is key to improving outcomes and reducing reoperations.
Area of Science:
- Orthopedics
- Spinal Surgery
- Biomechanical Engineering
Background:
- Adult spinal deformity (ASD) surgery has evolved from general alignment targets to patient-specific goals.
- Focus has shifted from health-related quality of life (HRQL) to preventing mechanical complications.
Purpose of the Study:
- To review sagittal alignment concepts and goals in ASD surgery.
- Analyze strengths and weaknesses of current alignment strategies.
- Identify key areas of debate in ASD surgical planning.
Main Methods:
- Narrative review of existing literature on sagittal alignment in ASD surgery.
- Discussion of traditional and modern alignment metrics.
- Analysis of compensatory mechanisms and their impact.
Main Results:
- Traditional sagittal alignment metrics (PI-LL, TK, SVA) may lack specificity for individualized planning.
- Pelvic retroversion and knee flexion are crucial for maintaining balance.
- Postoperative sagittal alignment significantly impacts HRQL and mechanical complications after spinal fusion.
- Eliminating compensatory mechanisms and restoring ideal spinal shape are vital for reducing complications.
Conclusions:
- Despite advancements in ASD alignment strategies, mechanical failures and reoperations remain a concern.
- Current alignment targets may not fully capture the relationship between sagittal alignment and functional outcomes.
- Further research is needed to refine alignment strategies for optimal patient results.
