====== AO Spine Knowledge Forum Deformity ======

The **[[AO Spine]] [[Knowledge]] [[Forum]] [[Deformity]]** is an [[international]] [[expert]] working [[group]] within AO Spine, focused on the study, [[standardization]], and advancement of care for **[[spinal deformity]]**, in both [[adult]] and [[pediatric]] [[population]]s.

===== Key Features =====

  * **Composition**: Comprised of leading [[spine surgeon]]s, [[clinical researcher]]s, biomechanical experts, and epidemiologists from top institutions around the world.

  * **Objectives**:
    * Develop **standardized alignment goals** and **surgical outcome criteria** for spinal deformities.
    * Conduct **high-quality multicenter prospective studies** to inform global best practices.
    * Establish **international consensus statements** on:
      * Surgical indications
      * Techniques
      * Patient selection
    * Promote **evidence-based approaches** and reduce regional variability in deformity management.

===== Role and Impact =====

The Forum plays a central role in shaping the future of spinal deformity care through:
  * Collaborative research
  * Rigorous methodology
  * Translation of findings into clinical guidelines and surgical education

It serves as a **global reference** for best practices in the treatment of complex spinal deformities.


====== Narrative Reviews ======
In a [[narrative review]]  
Pizones et al.  
from [[Hospital Universitario La Paz]]; additional centers in San Antonio, San Diego, Toronto, Barcelona, Charlottesville, New York  
published in the [[Global Spine Journal]]  
to critically examine evolving strategies in [[sagittal alignment]] targets for [[adult spinal deformity surgery]], shifting focus from generic [[HRQoL]] goals to preventing mechanical [[complication]]s  
Traditional [[alignment]] [[metric]]s (PI‑LL, SVA, TK) are limited for personalized [[planning]]; compensatory strategies (pelvic retroversion, knee flexion) are essential; individualized, structure-shape–based alignment (e.g., GAP, Roussouly, T4‑L1‑Hip‑Axis) reduces mechanical failure risk, though reoperation rates remain high  
((Pizones J, Hills J, Kelly MP, Alavi F, Nuñez-Pereira S, Smith JS, Sardar ZM, Lenke LG, Lewis SJ, Pellisé F; [[AO Spine Knowledge Forum Deformity]]. [[Alignment]] Goals in [[Adult Spinal Deformity Surgery]]. Global Spine J. 2025 Jul;15(3_suppl):108S-122S. doi: 10.1177/21925682251331048. Epub 2025 Jul 9. PMID: 40632289.)).

==== Critical Review ====
The narrative review offers a comprehensive appraisal of alignment paradigms, yet:

* **Strengths:** Integrates key classification systems; emphasizes pelvic and lower-extremity compensation; aligns recent evidence on shape-based vs. quality-of-life–based targets; timely discussion given recent advances (e.g., T4‑L1‑Hip‑Axis) 
 
* **Weaknesses:** Lacks systematic methodology or quantitative synthesis; conclusions primarily descriptive; limited [[critical appraisal]] of conflicting literature; evidence grade unclear  

* **Evidence gaps:** No robust [[meta-analysis]] to support superiority of new alignment strategies; minimal discussion on age-adjusted goals (e.g., Lafage et al., 2016, 2017) and their clinical endpoints 


==== Verdict ====
The article is a well-informed narrative but falls short of high-level [[evidence]]. It’s [[hypothesis-generating]] rather than definitive in guiding surgical [[decision-making]].  

**Rating: 6/10**

==== Takeaway for Practicing Neurosurgeon ====

Use alignment strategies that respect patient-specific morphology (like [[GAP]] and [[Roussouly Classification]]) and consider whole-body compensation. However, be cautious—this guidance is based on emerging concepts, not on strong comparative trials or comprehensive outcomes data.

==== Bottom Line ====

An informative review on evolving alignment goals—but lacking in solid evidence. A step forward in concept, yet insufficient as a standalone clinical guide until validated by robust comparative studies.

==== Citation ====
Published July 9, 2025.  

Corresponding author: Javier Pizones, Spine Surgery Unit, La Paz University Hospital, Madrid, Spain.