Feb 07

“My Rusty Old Back”

Back and leg pain in the elderly patient population is becoming more and more frequent due to the rapidly increasing elderly population over the age of 65. I frequently explain to my patients that the “Golden Years are not Gold……but Rust.” As we approach the age of 65 and older, our spines simply have “too many miles on the tires”, and so back pain and leg pain or weakness, is almost ubiquitous in the aging population.

The aging population in the US is rising exponentially. Due to the “baby boomer” generation, the number of elderly Americans over the age of 65 is rising extremely rapidly. In fact, the elderly population over the age of 65, has quadrupled in number in the last 10 years. Couple this with the fact that advances in heart disease prevention, and treatments have allowed Americans to simply live longer. While this is great news for our healthy hearts, the bad news is that our spine and joints continue to age.

The aging elderly spine is quite different from that of a young or middle age spine. As we age, we begin to collapse across the discs, leading to “shrinking” and that is one major reason that as we age, we get shorter. As our discs collapse and shrink, the bones and joints of the spine begin to rub against each other, causing bone spurs to form. These bone spurs are what frequently begin to press upon the nerves of the spinal cord, causing back pain and leg weakness in the elderly. This is called spinal stenosis. It is a natural process of aging, and if we live long enough, we will all have some form of spinal stenosis. So, because we are living longer with improved heart care, our spines are aging longer and longer, and spinal stenosis is becoming more and more frequent in the elderly population of the United States.

So, what can we do about this increasing prevalence of spinal stenosis? As spinal surgeons, we frequently try to first recommend non-operative care which sometimes includes mild medication, yoga and stretching, physical therapy and sometimes injections to the spine to help with the symptoms. The fact is, that these treatments help with the symptoms, but they do not get rid of the underlying bone spurs. As time goes on, and if patients live long enough, these treatments will likely no longer be effective as the disease progresses.

Traditional spine surgery, through open larger incisions, can be difficult for young patients, let alone the elderly who cannot tolerate such large operations. These traditional forms of spine surgery are often long operations, with higher blood loss, and longer hospital stays. None of these are ideal for the elderly patient who is at increased risk for complications. Therefore, at some point, surgeons often tell patients that they are simply too old or at too much risk for surgical treatment of removal of these bone spurs.

Modern techniques of Minimally Invasive Spine surgery have unlocked a surgical door of treatment once closed to the elderly. Modern spine surgery uses less invasive incisions and surgery with the use of scopes, microscopic technique, minimally invasive surgery to be able to remove bone spurs and help spinal stenosis patients, with incisions often smaller than one inch and surgery time of about an hour.

Since the year 2000, many breakthroughs have occurred in spinal surgery. Spinal operations are now performed via Minimally Invasive Techniques with tiny incisions, and shorter operative times, are ideal for the older patient population who simply cannot tolerate any kind of long major surgery. Many patients with spinal stenosis can be treated as outpatient surgery, and go home the same day as their procedure. Not only is this better for the patient by potentially protecting them from infection and other complications, but it is also less expensive.

The worry of “screws and rods” ……The other good news about the elderly, is that because they are already collapsed in their discs, they have become stiff already in their spines. While this may not seem like good news, the truth is, that this stiffness means that most elderly patients have spines that are already stable from this stiffness. Therefore, many of the elderly will not need screws or rods in their spines to stabilize their backs after removal of the spurs. In younger patients, this is often not the case. In other words, the elderly population, are frequently better candidates for smaller less invasive spine surgery, than some younger patients.

The bottom line is that the elderly can often benefit greatly from the new advances in spinal surgery with Minimally Invasive Techniques. The costs are lower for the elderly. The risks are lower for the elderly. The benefits are higher for the elderly. See if your surgeon thinks you are a candidate for MIS (Minimally Invasive Surgery) and the modern advances in spinal surgery.