Management of postoperative complications in spinal surgery patients with osteoporosis

Osteoporosis is a relatively common finding in patients undergoing spine surgery. Osteoporosis increases the risk for complications secondary to implant or bone union failure, including proximal junctional failure and pseudarthrosis. In cases of severe symptoms or progressive deformity, pathology-driven revision surgery may be required. In general, posterior surgery is commonly advocated in cases of fixed deformity with additional osteotomies and decompressions as needed. Conversely, an anterior approach is typically reserved for cases with flexible deformity and anterior compressive structures. In these cases, the use of autograft is also recommended in order to facilitate bone osseo-integration.