AO Innovation Translation Center - AO TC | July 2022

White Papers on Techniques and Considerations for Surgery of the Osteoporotic Spine

Maarten Spruit, Rick Bransford, Christian Mazel, Isador Liebermann, Osmar Moraes, Jean Ouellet, Kota Watanabe, Qian Bangping, Neil Binkley, Angela Cheung, Kassim Javaid, and Suzanne Morin

The AO Technical Commission is delighted to share the brand-new White Papers on Techniques and Considerations for Surgery of the Osteoporotic Spine.

Developed by expert spine surgeons of the AO Technical Commission's Osteoporotic Spine Surgery Task Force and specialists in endocrinology and bone health (see contributors below), the White Papers are based on literature review and expert opinion and give recommendations for osteoporotic spine surgery in 3 key focus areas:

The mission of the AO's Osteoporotic Spine Surgery Task Force is "to achieve optimal implant-bone fixation strength and construct stability to prevent early implant failure and late fusion//junctional failure with residual deformity".

Over the last year, the OSSTF has come up with recommendations for:

  • Which surgical patients aged 50 years or over need bone quality assessment with what investigations
  • Surgical Risk Category Algorithm
  • Medical management of osteoporosis in surgical patients

Surgical planning and technique: literature standards, recommendations, and opportunities for further research and development.

Junctional kyphosis and failure prevention: standards from literature, preoperative implant stress evaluation at upper end of long constructs, and opportunities for development for soft-landing devices.

We hope you find these recommendations useful.

Task Force Members


Maarten Spruit

Nijmegem, NL


Rick Bransford

Seattle, US


Christian Mazel

Paris, FR


Izzy Lieberman

Dallas, US


Osmar Moraes

São Paulo, BR


Jean Ouellet

Montreal, CN


Kota Watanabe

Tokyo, JP


Qian Bangping

Nanjing, CA

Invited Endocrinology and Bone Health Specialists


Neil Binkley

University of Wisconsin, US


Angela Cheung

University of Toronto, CA


Kassim Javaid

University of Oxford, UK


Suzanne Morin

McGill University, CA

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