Sagittal plane deformity in the adult patient.

Abstract Recent studies have demonstrated that sagittal balance is the most important and reliable radiographic predictor of clinical health status in the adult with a spinal deformity. Affected persons typically present with intractable pain, early fatigue, and a perception of being off-balance. Nonsurgical management with nonsteroidal and analgesic medications as well as physical therapy plays a limited role. Surgical correction is the primary method of alleviating symptoms. The surgical approach depends largely on the amount of correction required to restore overall balance. Options include posterior-only or combined anterior-posterior surgery. The decision-making process often includes posterior-based osteotomies, such as the Smith-Petersen or pedicle subtraction, or vertebral column resection. Regardless of approach or osteotomy technique, spinal fusion with restored sagittal balance is the goal of any reconstructive procedure.