The incidence of symptomatic adult spinal deformity (ASD) is increasing due to aging of the population, iatrogenic factors, and an increasingly active elderly population. Spinal deformity in the adult population can produce major functional disability. Patients with less severe forms of ASD can generally be managed without operative intervention. For those individuals with disabling pain, functional impairment, or progressive spinal malalignment, surgical treatment is available and effective. However, the surgery is complex and associated with a significant risk of perioperative complications. Efficacy and safety is optimal when operative intervention is performed by a surgical team (and hospital system) experienced in the management of complex spinal pathology. Quality of life for the ASD patient can be greatly improved with proper patient selection, technical execution, and perioperative care.