Spinal Surgery in Elderly
Aging is a “natural, inevitable, physiological change that leads to compromises in physical, mental and functional abilities of the patient”. Currently the global population is undergoing an upward shift in its age structure with increasing life expectancy. As a result, clinicians will be required to manage an increasing number of spinal disorders specific to the elderly and the aging spine.
Elderly individuals pose unique challenges to health care systems with increased number of medical comorbidities, reduced bone density mass, more severe spinal degeneration and a greater propensity to falls. There is, therefore, an increasing need to prove that surgery is cost-effective in the elderly and that it results in favorable outcomes with respect to pain, disability, quality of life, and functional status.
In clinical practice the two common spinal conditions seen in the elderly are spinal cord compression in the neck and similar compression in the back. The former presents with combination of weakness in grip and balance problems which tends to progress often rapidly with recurrent falls. Nerve compression or stenosis in the back (lumbar spine) typically presents with cramps, numbness, pain or tightness in legs which is worse with walking and improved with rest and leaning forwards. Gradually the walking distance reduces and impacts hugely on the quality of life. Both these conditions if identified early and treated operatively when there is severe narrowing, can make a massive difference to the patients quality of life. My view is that age alone should not be a determinant in offering life changing surgical procedures to patients.
If all conservative measures have been exhausted, provided patients are anesthetically fit, I would not hesitate to offer elderly patients surgery. I would try to screen those patients that would benefit from the procedure and also offer the simplest procedure with the shortest surgical time that would offer the best outcome to the patients.
Split Laminectomy for spinal cord compression in the neck is one such procedure that is minimally invasive, quick, simple and extremely effective in the appropriate patient.
Lumbar decompresson can be similarly effective when performed for severe narrowing of nerves in the lower back.
Fractures in the spine is often seen in the elderly due to soft bones (osteoporosis) associated with falls. Symptoms can include severe pain. The management is mainly conservative with often a brace to support the patient and assist in pain control. Occasionally strengthening the bone with some percutaneous injection of cement may offer significant pain control.