Approach options in adult spinal deformity surgery

Key objectives in adult spinal deformity surgery include sagittal and coronal alignment correction, bony fusion, alleviation of pain, and improved patient function. There are a variety of options for surgical approach and timing. Spinal deformity surgery can be approached anteriorly, posteriorly, and in a combined manner, with or without staging. Considerations in selecting an optimal surgical approach include the patient׳s sagittal alignment, bone quality, nutritional status, need for fusion across the lumbosacral junction, anterior column mobility, and the surgical team׳s technical expertise.