Surgical Alignment Goals for Adult Lumbar Scoliosis

Surgical management of adult spinal deformity is associated with substantial improvements in health-related quality-of-life scores; provided it is indicated appropriately, a reasonable surgical approach has been selected, and major complications avoided. Parameters to consider in surgical decision-making include clinical presentation, disability level, prior response to nonoperative treatment, and radiographic characteristics of the deformity, and baseline health status of the patient. Coronal and sagittal alignment targets have been conventionally defined based on radiographic correlation with health-related quality-of-life scores. However, recent research shows age-related changes exist in the radiographic alignment of the spine, which is distinct from pathologic degenerative changes. Therefore, an individualized approach for alignment targets is optimal. Mathematical methods can be helpful to predict postoperative radiographic results, but they should be used cautiously because of their inherent limitations. To achieve the goals of alignment restoration, surgery for adult spinal deformity generally consists of three elements: decompression, realignment, and fusion. All three can be performed with various techniques and approaches.