Patient-specific technologies within the field of adult spinal deformity (ASD) aid surgeons in pre-surgical planning, accurately help identify anatomical landmarks, and can project optimal post-surgical sagittal alignment. This narrative review aims to discuss the current uses of patient-specific technologies in ASD and identify new innovations that may very soon be integrated into patient care. Pre-operatively, machine learning or artificial intelligence helps surgeons to simulate post-operative alignment and provide information for the 3D-printing of pre-contoured rods and patient-specific cages. Intraoperatively, robotic surgery and intraoperative guides allow for more accurate positioning of implants. Implant materials are being developed to allow for better osseointegration and patient outcome monitoring. Despite the significant promise of these technologies, work still needs to be performed to ensure their accuracy, safety, and cost efficacy.

Study Design: Systematic review. Objective: To evaluate perioperative and clinical outcomes after open versus endoscopic lumbar decompression in patients with obesity. Summary of Background Data: Obesity is associated with increased technical difficulty and perioperative morbidity in lumbar spine surgery. Endoscopic spine surgery (ESS) may reduce soft tissue disruption and wound morbidity, but comparative data in obese patients remain limited. Materials and Methods: A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception through January 21, 2026. Studies were included if they enrolled adult patients with obesity undergoing lumbar decompression without fusion for degenerative pathology and reported at least one operative or perioperative outcome. Pediatric patients, nonlumbar or nondegenerative procedures, fusion-only cohorts, and nonprimary literature were excluded. Demographics, operative outcomes, complications, reoperation, and patient-reported outcomes were extracted and synthesized qualitatively. Results: Fourteen studies were included after screening 667 titles/abstracts and 93 full texts; 11 primary clinical studies informed the results synthesis. Two studies directly compared endoscopic and open decompression in obese patients. Ma and colleagues reported lower estimated blood loss after unilateral biportal endoscopic decompression compared with open surgery and shorter hospitalization. Castel and colleagues reported shorter hospitalization after full endoscopic lumbar discectomy compared with open surgery, although operative time was longer in the endoscopic cohort. Complications included surgical site infection, durotomy, nerve root injury, and recurrent disc herniation, with low event rates. BMI-stratified studies showed comparable pain and disability improvement between obese and nonobese patients. Conclusion: Based on limited comparative evidence from two studies, endoscopic decompression in obese patients was associated with similar clinical improvement and potential perioperative advantages compared with open surgery, including lower reported blood loss and shorter length of stay. Limitations include retrospective designs, heterogeneous techniques, only two comparative studies, and inconsistent reporting. These findings should be considered preliminary, and prospective comparative studies are needed. Level of Evidence: Level III.