» Although spine surgery is effective in reducing pain and improving functional status, it is associated with unacceptably high rates of complications, thus necessitating comprehensive preoperative patient optimization. » Numerous risk factors that can impact long-term surgical outcomes have been identified, including malnutrition, cardiovascular disease, osteoporosis, substance use, and more. » Preoperative screening and personalized, evidence-based interventions to manage medical comorbidities and optimize medications can enhance clinical outcomes and improve patient satisfaction following spine surgery. » Multidisciplinary team-based approaches, such as enhanced recovery after surgery protocols and multidisciplinary conferences, can further facilitate coordinated care from across specialties and reduce overall hospital length of stay.

Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients’ bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes.

Study Design: This is an evidence-based narrative review article. Objective: We aim to evaluate the impact of malnutrition on perioperative outcomes in spine surgery, particularly its association with sarcopenia and frailty, and emphasize the importance of standardized screening and management protocols. Background: Malnutrition is a significant yet often overlooked condition that affects spine surgery outcomes, contributing to higher morbidity, prolonged hospital stays, and increased health care costs. Despite its prevalence, there is a lack of consistent protocols for its identification and management in surgical practice. Methods: This review synthesizes existing literature on malnutrition in spine surgery, focusing on evidence-based methods for preoperative nutritional assessment, including laboratory markers, validated screening tools, and innovative imaging techniques such as full-body standing radiographs for muscle mass evaluation. Results: We explore nutritional optimization strategies, including targeted protein supplementation and multimodal dietary interventions, which have been shown to improve surgical recovery and minimize complications. The review also highlights the relationship between malnutrition, sarcopenia, and frailty, and their collective impact on perioperative outcomes. Conclusions: Given the growing recognition of perioperative nutritional status as a modifiable risk factor, implementing standardized protocols for malnutrition screening and management is essential to improving patient outcomes following spine surgery.