Purpose <p>Adult spinal deformity (ASD) surgery aims for radiographic correction to achieve meaningful improvements in pain, function, and quality of life. Psychologic readiness is increasingly recognized as an important factor associated with recovery and satisfaction. This review summarizes ASD-relevant data on psychologic readiness and presents a practical framework for screening and optimization.</p> Methods <p>A state-of-the-art review was performed using targeted searches of PubMed and Embase focused on ASD surgical populations and perioperative outcomes related to mental health symptoms, pain coping, sleep disturbance, opioid exposure, cognitive vulnerability in older adults, and expectation alignment. Evidence from broader spine surgery literature was incorporated when ASD-specific data were limited. Studies focused exclusively on pediatric deformity or non-operative cohorts were not emphasized.</p> Results <p>Baseline mental health symptoms, pain coping, sleep disturbance, opioid exposure, cognitive vulnerability, and expectation alignment are associated with disability burden, satisfaction, regret, perioperative utilization, and recovery experience after ASD surgery. Because the evidence base remains heterogeneous and largely observational, these factors are best used for risk stratification and targeted optimization rather than as categorical contraindications to surgery. A practical workflow includes brief pre-visit core screening, selective add-on tools when concerns are identified, three-tier readiness classification, and standardized responses to abnormal findings.</p> Conclusion <p>Psychologic readiness assessment can be incorporated into adult spinal deformity practice using a brief core screen, selective add-on tools, and a tiered response pathway. This practical approach allows surgeons to identify common readiness barriers, align expectations, and coordinate targeted optimization without unnecessarily delaying indicated surgery.</p>