Mobility is one of the central functions of humans. For it to be fulfilled, the spine, which is the central component of this function, has to work together with the rest of the musculoskeletal system in an intricate, complex manner to execute the required movements in a pain-free fashion. It has evolved through time to serve its functions, particularly in maintaining an upright posture, carrying weight, and facilitating mobility.
Owing to its complex nature, pain due to spinal disorders remains to be the leading cause of disability worldwide. With the decline in mobility comes the exacerbation of many chronic conditions. The societal and economic burden of spinal disorders continues to put pressure on the already heaving, vulnerable health care system.
It is difficult to get the actual number of people worldwide plagued by spine-related pathologies because an accurate health reporting system is not in place. Spinal cord injury alone affects 54 in every million Americans. It equates to about 18,000 annual cases, mostly affecting people in their 20s and at the peak of their productivity. These statistics, however, exclude those who immediately died at the incident of trauma.
Spinal disorders require long-term care and physical therapy. Spinal disorders result from different causes, but the mechanism mainly responsible for the pain and disability is the compression of nerves, usually due to instability of the segments of the spine. This problem is overcome primarily by medications, mobility aids like back straighteners and wheelchairs, and surgical interventions which aim to decompress and stabilize the affected segments.
Here are some of the common spinal disorders and how modern medicine takes on the challenge of providing affected ones with relief and cure:
Common Spinal Disorders
Stenosis or the progressive narrowing of the spinal canal is common in the elderly, owing to the degenerative changes that come with the aging process. In some cases, it can be congenital (e.g. failure of the spine to form segments or incomplete closure of the vertebral arch at the time of birth, etc.) or acquired (e.g. trauma, systemic diseases like Paget disease and ankylosing spondylitis). There is no clear correlation between this spinal disorder and sex, race, and other demographic factors like occupation and body type so there is no way of anticipating who gets affected.
While it can develop at any segment of the spine, the most commonly affected ones are those of the neck and the lower back. Spinal stenosis in the elderly is manifested by chronic pain. Severe spinal stenosis in the elderly leads to weakness and localized areas with reduced to no sensation depending on the degree of neural compression. You may observe them being clumsy or having difficulty walking. Some may complain of numbness.
Management goals for spinal stenosis in the elderly include relief of symptoms and prevention of sudden neurologic sequelae. A series of imaging modalities are done prior to initiating the treatment plan. Some medications of particular importance include anti-inflammatory agents, epidural steroid injections, and muscle relaxants. Spinal stenosis treatment in the elderly also employs physical therapy and the use of mobility aids. Lastly, with manifestations of acute neurologic sequelae (e.g. radiculopathy, claudications), a surgical evaluation for possible decompressive surgery may be done.
The elderly population is especially vulnerable to traumatic lesions of the spine. As they are at risk for falls, high-energy trauma is common in this population. The injuries sustained when they hit their back can be divided into three categories: compressive fractures (66%), rotational injuries (19%), and distraction injuries (15%). The danger here is that vertebral fractures compressing the spinal cord may ultimately lead to paralysis, persistent pain, and disability.
Compressive fracture treatment in the elderly requires a multidisciplinary approach comprising of pain medications, physical therapy, and surgical interventions. The goal here is to restore the normal alignment of the backbone, decompress the neural elements if needed, and achieve stabilization for initiating mobilization. Surgery, of course, depends on clinical symptoms and imaging results. When surgery is not an option and clinical outcomes cannot be maximized, compressive fracture treatment in the elderly may benefit from physical therapy and rehabilitation programs.
Tumors involving the spine comprise 16.4% of all bone neoplasms, which makes it quite often seen in clinics. They can be primary or metastatic tumors (i.e. spread of cancer cells from other primary sites like lungs, prostate, and breasts). As the tumor grows, there is an increased risk of vertebral fractures and subsequent spinal cord compression. It is of particular clinical relevance because preventing vertebral fractures can significantly improve the quality of life of the elderly with spinal tumors.
Like other spinal disorders, spine tumors treatment in the elderly involves a multidisciplinary approach with medications to relieve the symptoms (e.g. pain, fever, vomiting), chemotherapy, and possible surgery. Mobility aids like wheelchairs are useful in the late stages when walking independently can no longer be achieved.
Spinal disorders can result from a wide array of pathological processes like degeneration and trauma. Complications like chronic and persistent pain, permanent disability, and neurologic deficits continue to add societal and economic burden to affected parties.
The main challenge in managing spinal disorders in the elderly is to relieve the symptoms and prevention of neurologic deficits that contribute to disability and total dependency. Surgery can also be performed to decompress the neural elements to avoid permanent neurologic deficits. This, of course, involves careful planning and patient selection. Risks are always compared with the benefits of conducting the surgery. Along with possible surgical interventions, appropriate medications and physical therapy can help in treating these spinal disorders.
Lastly, in cases where medical therapy is the only choice, mobility aids like back straighteners and wheelchairs can significantly improve the quality of life of the elderly living with spinal disorders. These tools make it possible for them to perform their routine activities and integrate well into their communities.
- Galbusera, F. and Wilke, H.W. 2018. Biomechanics of the Spine: Basic Concepts, Spinal Disorders and Treatment. Academic Press/Elsevier Publication. San Diego, CA, United States.