Patient-Specific Spinal Alignment and Adult Deformity Surgery: Are All Patient Deformities the Same?

dult spinal deformity is a complex pathologic procA ess with many etiologies and several mechanisms of compensation. A complete understanding of patient-specific spinopelvic alignment is required to differentiate the origin of the deformity from postural compensatory mechanisms and, ultimately, to optimize surgical correction. Specific spinopelvic parameters have been shown to be invaluable in the evaluation and surgical treatment of adult spinal deformity. X-ray radiography is the principal tool used in the diagnosis of spinal deformity. Global and regional imaging with anteroposterior and lateral views in the standing and unsupported position can assess the true magnitude of the deformity in the presence of axial loading. Spinal deformity and recruitment of compensatory mechanisms are best evaluated with full 36-inch cassettes or full-body imaging. For purposes of standardization and for optimal visualization of critical landmarks, the ‘‘clavicle position’’ should be utilized when the patient stands unsupported in a position of comfort, with elbows fully flexed and fingers placed at the supraclavicular fossa.