AO Spine Clinical Practice Recommendations: Sagittal Alignment Assessment and Planning in Adult Spinal Deformity...

Area of Science:

• Spine Surgery
• Orthopedics
• Biomechanical Engineering

Background:

• Adult spinal deformity (ASD) presents complex alignment challenges.
• Current literature offers various patient-specific alignment planning methods.
• Standardized approaches are needed for effective ASD management.

Purpose of the Study:

• To curate relevant spine literature on patient-specific alignment planning in ASD.
• To develop clinical recommendations for interpreting and utilizing this evidence.
• To guide practicing clinicians in ASD preoperative planning and postoperative evaluation.

Main Methods:

• Literature review of key articles on patient-specific alignment planning for ASD.
• Development of clinical recommendations by expert consensus.
• Grading of recommendations based on methodological quality and expert opinion.

Main Results:

• Four key articles were selected and evaluated for methodological strength.
• The reviewed publications show an evolution in alignment concepts from descriptive to continuous.
• Models like Roussouly morphotypes, SRS-Schwab classification, GAP Score, and T4-L1-Hip axis offer complementary planning perspectives.

Conclusions:

• Integrated use of alignment planning models enhances preoperative planning and postoperative evaluation in ASD.
• Considering patient-specific factors (bone quality, reserve, goals) is crucial for individualized strategies.
• These advanced models support the development of more individualized and durable alignment strategies for ASD patients.