Causes of Spine Conditions in Geriatric Patients

• Degeneration due to aging – Wear and tear of the spine's joints, discs, and bones lead to conditions like spinal stenosis, degenerative disc disease, and osteoarthritis.
• Osteoporosis – Reduced bone density makes the vertebrae more susceptible to fractures and deformities.
• Previous trauma – Injuries from earlier in life may worsen with age and contribute to spinal instability.
• Tumours – Elderly patients with metastatic cancers may develop spinal metastases, which compromise the structural integrity of the spine.

Diagnosis

Diagnosis of spine issues in geriatric patients is typically made using a combination of clinical examination and advanced imaging techniques, including:

• MRI – The investigation of choice for soft tissue evaluation and nerve compression assessment.
• CT scan – Useful for detailed bone anatomy and evaluating complex fractures.
• X-rays – Provide a basic overview of bone structure and alignment.
• Bone density testing (DEXA scan) – Crucial in assessing the extent of osteoporosis and determining the risk of fractures.

Management of Spine Conditions in Geriatric Patients

Conservative Treatment

In many cases, surgery may be avoided or delayed with non-surgical treatments:

• Pain management – Anti-inflammatory medications, muscle relaxants, and analgesics are often prescribed to manage chronic pain.
• Physical therapy – Helps improve strength, flexibility, and mobility, and reduces the need for surgical intervention.
• Bracing – Supports the spine, prevents further deformity, and aids in healing fractures.
• Osteoporosis management – Medications to increase bone density and reduce the risk of future fractures.

Surgical Management

Surgery is considered for geriatric patients when conservative treatments fail, or there is significant nerve compression, instability, or deformity.

Common Surgeries for Geriatric Spine Conditions

1. Decompression Surgeries
   • Laminectomy – Removal of part of the vertebra (lamina) to relieve pressure on the spinal cord or nerves, often used in spinal stenosis.
   • Foraminotomy – Enlargement of the space through which the spinal nerve exits, often combined with laminectomy.
2. Fusion Surgery
   • Spinal fusion – Joining two or more vertebrae together using bone grafts and hardware to stabilize the spine and prevent painful motion.
3. Minimally Invasive Surgeries
   • Balloon kyphoplasty/vertebroplasty – Injection of bone cement into fractured vertebrae to stabilize compression fractures caused by osteoporosis.
4. Tumour-related Surgeries
   • Tumour resection and spinal stabilization – Surgery may be required to remove the tumour and stabilize the spine with hardware and bone grafts.

Factors Affecting Surgical Decisions

• Overall health – Comorbid conditions (diabetes, hypertension, cardiovascular issues) can complicate surgery and recovery.
• Bone quality – Poor bone quality due to osteoporosis may affect the type of surgery, particularly the choice of fixation techniques.

Postoperative Care

• Rehabilitation – Physical therapy is critical after surgery to help restore mobility and function.
• Pain management – Postoperative pain control using medication and physical therapy.

Prognosis

Geriatric spine surgery can significantly improve the quality of life for elderly patients by relieving pain, restoring mobility, and preventing further spinal deterioration. However, the outcomes depend on the patient’s overall health, the type of surgery, and the severity of the spinal condition.