2026-04-14T08:15:47Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/136312025-10-24T10:25:31Zcom_2072_378070com_2072_378040col_2072_378092

Alignment Goals in Adult Spinal Deformity Surgery Hills, Jeffrey Alavi, Fatemeh Smith, Justin Pizones, Javier Kelly, Michael Núñez-Pereira, Susana Pellise, Ferran Institut Català de la Salut [Pizones J] Spine Surgery Unit, La Paz University Hospital, Madrid, Spain. [Hills J] Department of Orthopedics UT Health San Antonio, TX, US. [Kelly MP] Department of Orthopedic Surgery, Rady Children’s Hospital, University of California San Diego, San Diego, CA, US. [Alavi F] Department of Orthopedic Surgery, Toronto Western Hospital, Toronto, ON, Canada. [Nuñez-Pereira S, Pellisé F] Unitat de Recerca de la Columna Vertebral, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Smith JS] Department of Neurosurgery, University of Virginia, Charlottesville, VA, US Vall d'Hebron Barcelona Hospital Campus Pacients - Satisfacció Columna vertebral - Malformacions - Cirurgia DISEASES::Musculoskeletal Diseases::Bone Diseases::Spinal Diseases::Spinal Curvatures Other subheadings::Other subheadings::Other subheadings::/surgery HEALTH CARE::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Health Status::Quality of Life ENFERMEDADES::enfermedades musculoesqueléticas::enfermedades óseas::enfermedades de la columna vertebral::desviaciones de la columna vertebral Otros calificadores::Otros calificadores::Otros calificadores::/cirugía ATENCIÓN DE SALUD::ambiente y salud pública::salud pública::medidas epidemiológicas::demografía::estado de salud::calidad de vida Adult spinal deformity; Health related quality of life; Surgical alignment goals Deformidad espinal en adultos; Calidad de vida relacionada con la salud; Objetivos de alineación quirúrgica Deformitat espinal en adults; Qualitat de vida relacionada amb la salut; Objectius d'alineació quirúrgica Study Design Narrative review. Objectives Adult spinal deformity (ASD) surgery has progressively transitioned from mean regional alignment targets to individualized segmental alignment goals, and from health-related quality of life (HRQL) alignment goals to the prevention of mechanical complications. Methods Narrative review discussing sagittal alignment concepts and goals in ASD surgery. Results Traditional metrics for measuring sagittal spinal alignment such as pelvic incidence - lumbar lordosis (PI-LL), thoracic kyphosis, and sagittal vertical axis (SVA) may lack the specificity necessary for individualized alignment planning. Compensatory pelvic retroversion and knee flexion are critical determinants of maintaining the upright position. Research has been conflicting as to whether postoperative sagittal alignment is associated with improvements in HRQOL’s. However, this may reflect a lack of sensitivity in the traditional alignment targets and PROM’s measures, rather than a true lack of relationship between sagittal alignment and functional outcomes. Recent studies show that sagittal parameters have a limited impact on HRQL scores in non-operated patients, but significantly impact post-operative HRQOL measures and mechanical complications in patients treated with spinal fusion. Latest evidence suggests that compensatory mechanisms need to be eliminated and the ideal shape needs to be restored with surgery, to reduce postoperative mechanical complications. Multiple alignment strategies are proposed for that purpose. Conclusions While best evidence shows an improvement in ASD alignment strategies over the last decade, mechanical failures and reoperations are still a cause for concern. This narrative review analyzes the strengths and weaknesses of the different alignment strategies and identifies the main areas of debate. 2025-09-09T11:28:23Z 2025-09-09T11:28:23Z 2025-07 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Pizones J, Hills J, Kelly MP, Alavi F, Nuñez-Pereira S, Smith JS, et al. Alignment Goals in Adult Spinal Deformity Surgery. Glob Spine J. 2025 Jul;15(3_suppl):108S-122S. 2192-5690 http://hdl.handle.net/11351/13631 10.1177/21925682251331048 40632289 001525582200010 http://hdl.handle.net/11351/13631 eng Global Spine Journal;15(3_suppl) https://doi.org/10.1177/21925682251331048 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf SAGE Publications Scientia