The Importance of Bone Health in Complex Spine Surgery

Osteoporotic patients undergoing complex spine surgery provide a challenge for spine surgeons. Given the high and increasing prevalence of osteoporosis worldwide, this problem has come to the forefront in our community. It is important for spine surgeons to have an understanding of the disease process and its management as they seek to plan successful surgery and minimize potential risks. Specifically, osteoporotic patients have an increased risk of postoperative failure in the form of mechanical failure of the bone/implant interface, junctional failure, pseudarthrosis, or even metachronous fractures of other sites such as the spine, hip, or wrist. A wide array of surgical techniques and implant technology that can be used to minimize the risk of surgical failure, but equally important is identification of the underlying disease process, correcting secondary disorders, and managing bone health pharmacologically. This review article seeks to provide spine surgeons with information on osteoporosis and how to optimize patients for surgery while also obtaining the best possible surgical results.