Surgical management paradigms of spinal pathologies in the aging population carry inherent substantial risks, with surgical complications being more prevalent among patients with osteoporosis compared to those with normal bone mineral density. In this narrative review, we aim to highlight important clinical understanding and considerations in perioperative evaluation and management of patients elected to undergo spinal surgery. Osteoporosis is a well-defined risk factor for mechanical complications following spinal surgery, and as such, perioperative optimization of bone health in the setting of surgery for geriatric patients remains a critical research area alongside intraoperative surgical augmentation techniques. Surgical techniques to circumvent challenges with instrumentation of poor bone mineral density have included augmentation of pedicle screw fixation, including segmental bicortical screw fixation techniques, cement augmentation with fenestrated screws, or use of expandable pedicle screws to improve bone-implant interface. Judicious selection of treatment modalities and subsequent perioperative optimization is paramount to minimize surgical complications. Contemporary guidelines and evolving paradigms in perioperative evaluation, optimization, and management of the aging spine include the advent of quantitatively evaluating computed tomography (CT) via assessment of the magnitude of Hounsfield units. Prescribing pharmacotherapeutic agents and monitoring bone health requires a multidisciplinary team approach, including endocrinologists and geriatricians to coordinate high-quality care for advanced-age patients who require surgical management of their spinal disorders.

老龄化人群中脊柱病变的手术治疗模式具有固有的巨大风险，与骨矿物质密度正常的患者相比，骨质疏松症患者的手术并发症更为普遍。在这篇叙述性综述中，我们的目的是强调对选择接受脊柱手术的患者进行围手术期评估和管理的重要临床理解和考虑因素。骨质疏松症是脊柱手术后机械并发症的一个明确的危险因素，因此，老年患者手术过程中骨健康的围手术期优化仍然是与术中手术增强技术一起的关键研究领域。规避骨密度较差器械带来的挑战的外科技术包括增强椎弓根螺钉固定，包括节段双皮质螺钉固定技术、用有孔螺钉进行骨水泥增强，或使用可扩张椎弓根螺钉来改善骨-种植体界面。明智地选择治疗方式和随后的围手术期优化对于最大限度地减少手术并发症至关重要。老化脊柱围手术期评估、优化和管理的当代指南和不断发展的范式包括通过评估亨斯菲尔德单位的大小来定量评估计算机断层扫描 (CT) 的出现。处方药物治疗药物和监测骨骼健康需要多学科团队的方法，包括内分泌学家和老年病学家，以协调对需要手术治疗脊柱疾病的高龄患者的高质量护理。