Patients that undergo spinal reconstructive surgery are nutritionally at risk. The elderly, the chronically ill, and the developmentally disabled are often malnourished preoperatively. Those patients undergoing combined or staged anterior and posterior procedures often become malnourished in the postoperative period. Poor nutritional status is unequivocally associated with increased postoperative complications, including infectious complications. Close attention should be paid to the perioperative nutritional status of these patients and strong consideration given to preoperative and postoperative nutritional supplementation when indicated.