Abstract Objectives To assess how often adult spinal deformity (ASD) surgery achieves preoperative sagittal alignment goals, whether corrections are durable, and the impact of planning frameworks and enabling technologies. Methods A PRISMA-guided search of MEDLINE, EMBASE, Web of Science, Cochrane Library, and Scopus through June 2025 identified studies of adults undergoing ASD surgery where alignment targets were defined by numeric thresholds (for example SVA, PI–LL, PT), algorithmic frameworks (for example Roussouly, GAP), or technology-assisted modalities (for example virtual planning, patient-specific rods, robotics, custom implants). Outcomes included plan-to-achieved fidelity, durability, complications, and PROMs. Random-effects meta-analyses were performed when data were sufficiently homogeneous (SVA 5 cm, PI–LL ≤10°, PT ≤20°). Results Fifteen studies (2006–2025) with ∼1980 patients were included. Cohort sizes ranged 15–608; mean age was 65 years (58–72) and 68% female. Mean follow-up was 20 months (immediate to 5 years). Most patients met early postoperative targets for SVA, PI–LL, and/or PT, though durability attenuated at longer follow-up. Algorithm-driven planning—especially restoration to a Roussouly-consistent profile—was associated with fewer mechanical complications. Technology-assisted approaches improved plan-to-achieved fidelity but showed inconsistent PROM gains. Study quality varied: small single-center series were higher risk, while larger prospective cohorts showed lower but heterogeneous risk. Conclusions ASD surgery often achieves sagittal targets initially, but long-term durability is variable. Algorithmic frameworks predict fewer complications, and enabling technologies improve fidelity without consistent PROM gains. Future studies should standardize goals, assess durability beyond two years, and link alignment fidelity to patient-centered outcomes and cost.
Akil et al. (2026) studied this question.