Preventing Pseudoarthrosis and Proximal Junctional Kyphosis: How to Deal with the Osteoporotic Spine.

The increase in the aging population has led to an overall increase in the number of elderly patients undergoing spinal fusion surgery. This patient population, however, exhibits significant treatment challenges because of poor bone quality. By virtue of exhibiting decreased pullout strength and insertional torque, osteoporotic patients are at a substantial risk of developing vertebral fractures, instrumentation failure, pseudoarthrosis, and proximal junctional failures. It is, therefore, imperative for the treating surgeon to optimize bone health before recommending a spinal fusion surgery. Several preoperative medical therapies (vitamin D, calcium, bisphosphonates, parathyroid hormone, and so forth) exist to optimize bone health.