• Samuel A Joseph, Anthony P Moreno, Jared Brandoff, Andrew C Casden, Paul Kuflik, and Michael G Neuwirth.
• Department of Orthopaedics, University of South Florida, Tampa, FL,USA.
• J Am Acad Orthop Sur. 2009 Jun 1; 17 (6): 378-88.

AbstractRecent 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.

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