Sagittal Balance in Spinal Deformity Surgery

Sagittal balance is fundamental to the evaluation and management of spinal deformities, exerting influence on critical patient outcomes such as quality of life, functional capability, and long-term health. It reflects the interconnected relationship among key sagittal parameters, such as pelvic incidence, lumbar lordosis, sacral slope, and sagittal vertical axis, which shape the body’s compensatory mechanisms for sagittal imbalance and surgical objectives. Modern treatment approaches emphasize tailoring treatments to individual patients and respecting individual anatomic variation rather than relying on uniform alignment targets. This review synthesizes current clinical evidence, highlights key principles for treating and managing spinal deformities, and surveys emerging technological innovations alongside the potential improvements they present.