Level selection for optimal adult spinal deformity correction: A narrative review

Adult spine deformity (ASD) is the loss of the normal sagittal and coronal alignment necessary to maintain the head over the hips. ASD increases energy expenditure to maintain normal balance and horizontal gaze, and can lead to chronic pain, fatigue, and significant functional disability. Selection of upper and lower instrumented levels for ASD constructs is critical to achieving and maintaining an optimal post-operative alignment. While classifications and recommendations have improved level selection strategies, decision-making still remains largely dependent on the individual surgeon. This work summarizes available literature on level selection for ASD constructs.