Study Design: Narrative review Objective: Decision making in surgery for adult spinal deformity (ASD) is complex due to the multifactorial etiology, numerous surgical options, and influence of multiple medical and psychosocial factors on patient outcomes. Predictive analytics provide computational tools to analyze large data sets and generate hypotheses regarding new data. In this review, we examine the use of predictive analytics to predict patient-reported outcomes (PROs) in ASD surgery. Methods: A search of PubMed, Web of Science, and Embase databases was performed to identify all potentially relevant studies up to February 1, 2020. Studies were included based on the use of predictive analytics to predict PROs in ASD. Results: Of 57 studies identified and reviewed, 7 studies were included. Multiple algorithms including supervised and unsupervised methods were used. Significant heterogeneity was observed with choice of PROs modeled including ODI, SRS22, and SF36, assessment of model accuracy, and with the model accuracy and area under the receiver operating curve values (ranging from 30% to 86% and 0.57 to 0.96, respectively). Models were built with data sets of patients ranging from 89 to 570 patients with a range of 22 to 267 variables. Conclusions: Predictive analytics makes accurate predictions regarding PROs regarding pain, disability, and work and social function; PROs regarding satisfaction, self-image, and psychologic aspects of ASD were predicted with the lowest accuracy. Our review demonstrates a relative paucity of studies on ASD with limited databases. Future studies should include larger and more diverse databases and provide external validation of preexisting models.