Targeted nutritional supplementation (TNS) has been successfully used in multiple clinical settings. Enhanced outcomes have been seen for many years in burn, plastic, ulcer, and reconstructive surgery of head & neck cancer. The rationale for supplementing is based primarily on studies that show an increase in wound breaking strength and collagen formation in these challenging patient populations.  

Similar concerns are seen with spine fusion patients in which a successful clinical outcome depends on adequate collagen synthesis to allow for wound / bone healing and graft incorporation.

Recent studies have also demonstrated TNS to improve post-op fusion rates and decreased complications in orthopedic trauma (1)  and posterior spine fusion patients (2,3).

Reported rates of nonunion following posterior spinal fusion range from 0-70%. Rates are variable due to the various operative techniques, underlying diagnoses as well as patient variables. Malnutrition, tobacco use, chronic oral anti-inflammatory use, multilevel fusion, prior spine surgery, and sagittal imbalance are all risk factors for spinal nonunion.

Nutritional status has been identified to be a strong predictor of surgical outcomes in orthopaedic trauma, total joint arthroplasty, spine, shoulder arthroplasty, rotator cuff repair as well as distal radius fractures.

Advances in nutritional supplementation can be implemented to support patients recovering from spinal procedures to aid in improving fusion rates and as well as mitigate post-op muscle loss aimed to accelerate functional recovery.