Complex spinal surgery in patients with osteoporosis: Tips and tricks for achieving adequate constructs and avoiding complications

Osteoporosis presents a unique set of challenges for instrumentation and correction of spinal deformity, both due to the unique pathology created by the disease and the technical considerations for obtaining spinal fixation. As a result, the spine surgeon is faced with the challenge of needing a robust reduction method to achieve stability in a relatively weak medium. Complications from fixation failure most frequently present as pedicle screw pullout and junctional failure. Many solutions have been offered to improve construct strength from preoperative therapeutics to intraoperative surgical adjuncts. From our experience, we review several promising strategies.