Abstract Optimal treatment of adult spinal deformity patients requires an understanding of radiographic parameters that are correlated to improved health-related quality of life (HRQOL) outcomes. The correlation between radiographic parameters and HRQOL measures is well established and is underscored in new adult spinal deformity classification systems such as the SRS-Schwab. Treating surgeons should focus on restoring global spinopelvic alignment, including keeping the SVA within 5cm, the pelvic tilt to within 25°, and the lumbar lordosis proportional to the pelvic incidence. Improvements in management of adult spinal deformity will come through greater understanding of radiographic parameters that correlate with changes in disease state and patient-reported outcomes.