Solutions for an Aging Spine
According to the World Health Organization, the proportion of people over the age of 60 is growing faster than any other age group. While this may be a success story for medicine and prevention of disease, it presents our society with challenges relating to preservation of physical function and quality of life issues for this group. In short, patients are living longer – with increasing expectations that they will live their lives productive and painless. Unfortunately, time, occupational hazards, and old injuries take their toll on the spine. This results in unique clinical problems for the aging spine including disc degeneration, lumbar spinal stenosis, osteoporotic compression fractures and spondylolisthesis. Advances in medicine and technology are working with this patient population to improve lives through Minimally Invasive Spine Surgery (MISS).
“Just like you get wrinkles on your face, you get ‘wrinkles’ on your spine,” says minimally invasive spine surgeon Christopher Wagener, M.D. “It is part of the normal aging process. However, there are options today that were unavailable even a few years ago to help us combat the pain and disability that was previously thought to go hand- in-hand with aging.” The benefits of Minimally Invasive Spine Surgery include less pain, less bleeding, shorter hospitalization, and earlier return to function.
For patients that are experiencing symptoms in their back and neck, a complete history and physical exam should be performed by a qualified medical professional. Imaging studies such as X-rays, MRI or CT may provide additional information with regard to diagnosis, disease progression, and treatment options. In nearly every instance, non-operative treatment options are available. However, for those who are have certain conditions or exhausted conservative measures, MISS is often the best option.
“Many patients do not even think they could even be a surgical candidate so they live in severe pain,” Wagener says. What they do not recognize is that inactivity often causes them to gain weight, lose function and can worsen heart and lung conditions. The end result is a sicker patient with more disability. Wagener adds, “I am operating on more and more patients in their 80s. Sometimes they do better than their much younger counterparts. Because I have a less invasive option, people who were once thought of as poor surgical candidates are now ideal patients for these procedures.”
The spine consists of structural blocks of bone (vertebrae) separated by gel-like discs that act as shock absorbers. As we age, there is loss of water and a change in the chemical composition of the discs. This results in loss of height of the discs as well as their ability to absorb the load of the body as it performs normal activity. This can result in bulging of the disc, the formation of bone spurs, pinching of the spinal cord or nerves and pain.
Treatment for this problem consists of conservation modalities such as anti-inflammatories, physical therapy, and epidural injections. Often, consultation with a physiatrist – a physician that specializes in physical medicine and rehabilitation – is appropriate.
Lumbar Stenosis and Spondylolisthesis
As the spine degenerates, in addition to the collapse of the disc spaces and formation of bone spurs, various stability structures and ligaments thicken. This change in structure occurs in close proximity to nerves resulting in spinal stenosis. Wagener adds, “Stenosis simply means pinching of nerves. If the collection of nerves in the lumbar spine is pinched, patients complain of heaviness in the legs, with difficulty walking long distances. They need to use a shopping cart at the grocery store or take frequent sitting breaks when they have to stand for long periods of time.” He continues, “If an individual nerve is pinched, this can cause radicular pain, or sciatica, which is pain that radiates below the knee.”
Spondylolisthesis involves the slipping of one vertebra on another creating the most common deformity of the spine. Unfortunately, as the bones of the spine move relative to one another, it inevitably results in spinal stenosis and pain. Most commonly occurring between the fourth and fifth lumbar vertebra, it is often found in women over 55 years old.
For those patients that exhaust the conservation measures previously addressed for disc degeneration, surgical options can significantly improve symptoms. “I feel very fortunate to be able to offer patients a minimally invasive option, “ Wagener states. “It significantly reduces post-operative pain, decreases blood loss, and cuts hospital stays in half. It is an enormous difference for the patient.”
Osteoporotic Compression Fractures
Peak bone mass or the amount of bone tissue one develops in their “bone bank” reaches its maximum for most people in their mid-to late 20s. From that point in time, the amount of bone one has in storage will remain relatively constant until there are changes in hormone levels such as when women go through menopause. Following this, there are several years where there is rapid loss, resulting in weaker bone and more susceptibility to fracture. Often these fractures can cause deformity and pain.
Previously, this condition was routinely treated with bulky and uncomfortable braces that patients wore for months. Now, with advances in minimally invasive techniques, surgeons can access these fractures with small cannulas/needles, injecting the area with cement that consolidates the painful areas. “Immediate fracture stabilization obviates the need for bracing and provides instant relief,” reports Wagener.
Indeed, the aging spine can be challenging for patients, families, and physicians. The older population is not only increasing, but they also have the desire to be more active so they can enjoy their grandchildren and family, travel, or just continue with their normal activities of daily living. These conditions can be debilitating, interfering with quality of life but there are solutions that can be life changing. Only your doctor can determine if you are a good candidate for these advanced treatments.
Amanda Boyce, ATC, CSCS, is the Director of Marketing for Coordinated Health and has an extensive background and training in the field of sports medicine.
Christopher Wagener, M.D., is an expert in Minimally Invasive Spine Surgery. For more information or to schedule an appointment call Coordinated Health at (877) 247-8080. Visit Coordinated Health’s YouTube page: CoordinatedHealthTV for a more detailed look at Minimally Invasive Spine Surgery.