Nutritional Optimization in Spine Surgery: A Review of Its Implications for Postoperative Recovery and Outcomes

Poor nutritional status is a modifiable risk factor that has been shown to have adverse outcomes in spine surgery, including higher rates of complications, poorer functional outcomes, longer hospital stays, and increased healthcare costs. As such, interest has emerged in clinical practice regarding the use of tools and important nutrient profiles that can be used to assess nutritional status both pre- and postoperatively. The purpose of this review is to synthesize the current evidence surrounding the clinical utility of various nutritional screening tools, as well as to evaluate the importance of targeted interventions. These strategies include protein and amino acid supplementation, vitamin D optimization, and preoperative carbohydrate loading; prior studies have associated these interventions with improved fusion rates, lower infection risk, and accelerated recovery. Furthermore, economic analyses in the setting of nutritional optimization are explored. Despite these benefits, substantial barriers like inconsistent protocols and patient nonadherence remain. In addition, reliance on single markers like albumin may be misleading due to inflammatory confounding, highlighting the need for multifactorial assessment that incorporates surrogates of bone quality and baseline health status. As the spine surgical population ages and procedures grow more complex, preoperative nutritional optimization represents a low-risk strategy with potential for substantial advancements in patient recovery. This review advocates for the standardization of multidisciplinary nutritional protocols as a key component of comprehensive perioperative spine care.