In recent years, the importance of sagittal plane alignment in the energy-efficient functioning of the individual has been underscored. Sagittal plane malalignment is a principal cause of disability in patients with spinal deformity and other spinal pathologies. It is associated with numerous conditions including degenerative disc disease, Scheuermann’s kyphosis, spondylolisthesis, posttraumatic kyphosis, ankylosing spondylitis, and iatrogenic flatback deformity. Regardless of surgical technique, whether traditional or MIS, restoration or maintenance of sagittal alignment is paramount to achieving optimal functional outcomes.
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