The Aging Spine

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However, there is a substantial risk of progressive disk degeneration at this level, and in patients with sagittal imbalance, also a risk for recurrence of the imbalance.

Osteoarthritis & Related Conditions

This added fixation increases the fusion rate by three times, relieves strain on the S1 screws, and protects against screw pullout. Where to stop at the upper end of the construct is also a matter of controversy. Although initial studies suggested that crossing the thoracolumbar junction and stopping the construct at T9 or T10 would lead to fewer proximal problems, more recent reports have suggested that this is not so.

UCLA Spine Center - James' Story

Proximal junctional failure—no matter which specific level is chosen as the upper instrumented vertebra—remains a significant concern. To date, no clear strategy has emerged as optimal to prevent this complication. Spinal deformity surgery in the elderly is increasingly common, with concern for management of sagittal and coronal imbalance as well as the frequently accompanying spinal stenosis.

High complication rates remain a challenge and should be given careful consideration before embarking on surgery. Nonsurgical measures are often successful at controlling symptoms. When proceeding with surgery, osteoporosis and the parameters that affect sagittal imbalance should be identified. Treatment may require an osteotomy, and the levels to include in the fusion should be given careful consideration.

References printed in bold type are those published within the past 5 years. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Visit our other educational websites: AAOS. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.

For more information, please refer to our Privacy Policy. Subscribe to eTOC. Advanced Search. Toggle navigation. Register Login. Your Name: optional. Your Email:. Colleague's Email:. Separate multiple e-mails with a ;. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Received May 11, Accepted August 10, Back to Top Article Outline.

Table 1. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Cited Here February 06, Accessed October 16, Orthopedics ;37 12 :e—e J Clin Endocrinol Metab ;96 7 — Carlberg C: The physiology of vitamin D-far more than calcium and bone. Front Physiol ;5 5 Nutrients ;7 6 — Age Ageing ;43 5 — JAMA Surg ; 2 — BMC Geriatr ; PubMed CrossRef. Ross AC: The report on dietary reference intakes for calcium and vitamin D. Public Health Nutr ;14 5 — Vieth R: Vitamin D supplementation, hydroxyvitamin D concentrations, and safety.

Am J Clin Nutr ;69 5 — Ann Epidemiol ;19 7 — Preventive Services Task Force. Accessed October 14, J Pharm Bioallied Sci ;6 4 Osteoporos Int ;26 2 — Clin Orthop Surg ;5 4 — J Bone Joint Surg Am ;94 23 — J Bone Joint Surg Am ;93 17 — Spine Phila Pa ;37 23 :E— Spine Phila Pa ;38 8 :E—E J Clin Densitom ;17 4 — J Bone Miner Res ;29 9 — Osteoporos Int ;25 12 — J Bone Joint Surg Am ;96 7 :e Spine Phila Pa ;35 19 :E—E J Spinal Disord Tech ;23 6 — DeWald CJ, Stanley T: Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age Surgical considerations and treatment options in patients with poor bone quality.

Natural history of the aging spine

Spine Phila Pa ;31 19, suppl S—S Eur Spine J ;23 10 — Spine Phila Pa ;22 9 —, discussion J Spinal Disord Tech ;22 6 — Spine Phila Pa ;36 6 — Spine Phila Pa ;37 26 :E—E Global Spine J ;4 1 — Kerry G, Ruedinger C, Steiner HH: Cement embolism into the venous system after pedicle screw fixation: Case report, literature review, and prevention tips. Orthop Rev Pavia ;5 3 :e Spine Phila Pa ;38 9 — J Spinal Disord Tech ;23 8 — The facet joint also demonstrates irregular hypertrophy, osteophytes and loss of joint space open arrow. Degeneration of these structures lead to instability, resulting in anterolisthesis of L4 over L5.

B, Axial image in soft tissue window demonstrates diffuse disc bulging white arrows , thickening of the ligamentum flavum black arrows , and facet arthropathic changes that include joint space narrowing, facet hypertrophy, and vacuum phenomenon in the facet joints open arrow. These changes lead to severe spinal canal stenosis, with the thecal sac T severely compressed anteriorly and posterolaterally. A, Axial image at the L3-L4 intervertebral level demonstrates a left central disc protrusion open arrow , causing stenosis and impingement of the nerve roots at the left lateral recess.

By comparison, the right L4 nerve root at right lateral recess white arrow is floating freely within the thecal sac. B, At the L2-L3 level, there is severe spinal stenosis as a result of disc bulging, ligamentum flavum hypertrophy, and facet arthropathic changes that include facet hypertrophy and sclerosis circle , resulting in almost complete obliteration of the cerebrospinal fluid space arrow.

MRI provides the best soft tissue details of degenerative disc disease. In young healthy patients, the intervertebral discs demonstrate hyperintensity on T2-weighted images. With aging, there is loss of this hyperintensity due to a decrease of water content and changes in proteoglycan composition Figure There is decreased disc height and the endplates may become irregular. Gas from vacuum phenomenon may fill the space of a degenerative disc, which may demonstrate hypointensity on both T1- and T2-weighted images.

Alternatively, the space may be filled with fluid, which is seen as hyperintensity on T2-weighted images. A degenerative disc may also calcify, which can give hypointensity or hyperintensity on T1-weighted images, depending on the type and concentration of calcification. A degenerative disc may also enhance secondary to the presence of granulation tissues.

The Open Orthopaedics Journal

There is disc space narrowing and loss of the normal T2 hyperintensity of the L4-L5 disc. Bulging of the disc with a small protrusion into the spinal canal is also shown arrow. Fissures of the annulus fibrosus may be seen in the intervertebral discs. On MRI, annular disruptions also referred as fissures may be seen as a small high intensity zone within the outer annulus Figure One of the primary advantages of MRI is the direct visualization of disc bulging or herniation, and its associated mass effect on the nervous structures.

At a particular disc level, a disc can have bulging and one or more areas of herniation seen on the same occasion. In , multiple societies reached a consensus to standardize the nomenclature and classification of disc pathology. Williams, S. Rothman, R. Murtagh, G. Papers Table of contents 18 papers About About these proceedings Table of contents Search within book.

CE International - Therapeutic Exercise for the Aging Spine & Pelvis - A Hands-On Workshop

The aging of the population: a growing concern for spine care in the twenty-first century. Pages Natural history of the aging spine. Overview of osteoporosis: pathophysiology and determinants of bone strength. Biomechanics of the aging spine. Recognizing and reporting osteoporotic vertebral fractures. Roemer, Pierre D. Delmas, Harry K. Principles of management of osteometabolic disorders affecting the aging spine. Alexander G. Hadjipavlou, Paul G. Katonis, Michael N.

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