Aging Spine: Older Doesn't Mean More Painful

Time, old injuries and bad habits take their toll on the spine as you age. But new treatments and better diagnostic tests can help keep back pain at bay throughout an entire lifetime. There are several diseases that can lead to low back pain in the aging spine including disc degeneration (deterioration), lumbar spinal stenosis and spondylolisthesis (displacement of a vertebra by the one above it).

"The spine goes through the aging process just like any other part of the body," Stan Pelofsky, MD, Neurosurgery Today Editorial Board Chair and a neurosurgeon in Oklahoma City said. "Many of these conditions reduce the quality of life and patients tend to just accept them as a consequence of getting older. But, it doesn't have to be that way and these patients need to see a neurosurgeon early in the disease stage in order to develop a long-range treatment plan."

For patients with a history of back pain and who are currently experiencing symptoms that are interfering with activities, the first step is proper diagnostic testing to determine the cause of the symptoms and the severity of problem. A series of imaging tests over a period of time can help the neurosurgeon monitor the disease progression and determine the correct course of treatment.

Studies have shown that age is not a major factor in determining whether someone will benefit from surgery, although some conditions associated with age, such as high blood pressure or diabetes can influence their surgical risks. "A patient is never 'too old' to undergo surgery," Dr. Pelofsky said. "Spine surgery provides great relief to patients well into their 80's."

Disc Degeneration

One of the most common disorders in the lower spine is disc degeneration, or osteoarthritis in the spine. The spine is made up of bones, or vertebra, and softer, gel-like discs. As the body ages, the discs in the spine dehydrate, or dry out, and lose their ability to act as shock absorbers. The bones and ligaments that make up the spine also become less pliable and thicken. Degeneration in the discs is normal and is not in itself a problem. The problem happens when these discs began to pinch and put pressure on the nearby nerve roots or spinal cord.

Treatment plans for patients with disc degeneration in the spine are often long and conservative with the focus on relieving the pressure on the nerve. Neurosurgeons will often prescribe an array of treatments including physical therapy, anti-inflammatory medications, steroid injections, and a consult by a physiatrist, a physician who specializes in rehabilitative medicine.

Lumbar Spinal Stenosis

Another result of degeneration of the spine is lumbar spinal stenosis (LSS). This disease involves a narrowing of the canal that houses the spinal cord and nerve roots. Because the spinal canal is narrowing, the entire spinal cord is often being compressed, not just a single nerve.

Patients who suffer from LSS often experience weakness and pain in the legs, a dull pain in the lower back when they walk or stand, numbness or pins and needles in their legs or buttocks when they walk or stand, and often get relief when sitting or bending forward when they walk or leaning on a shopping cart. Symptoms of LSS usually occur in patients over the age of 50.

Once a diagnosis has been confirmed and the severity of the stenosis has been assessed, the physician will explore the most appropriate avenue of treatment, including medications, physical therapy and surgery. Many patients respond well to conservative treatment --, which includes anti-inflammatory medications, physical therapy, cortisone injections -- for quite a few years. Should surgery become an option, your neurosurgeon will carefully review your history, conduct a physical exam and imaging studies to determine the most appropriate procedure for you. The surgical remedy focuses on opening up the spinal canal and relieving the pressure from any nerves that are being irritated.

"Degeneration and lumbar spinal stenosis are often a package deal and therefore the surgery can be fairly comprehensive," Russell L. Travis, MD, a frequent lecturer on spine care and a neurosurgeon in Kentucky said. "However, over 80 percent of LSS patients have dramatic increases in their quality of life after spine surgery and can return to their active lifestyles."

Degeneration in the spine also can lead to spondylolisthesis, a condition characterized by the slippage of a vertebra in the spine. In this disease process, a vertebra is displaced out of line with the other adjacent vertebra. Like all other spine disorders, conservative treatment often provides relief and pain doesn't become severe unless a nerve root is irritated.

"The most important thing to remember with back pain is that surgery is one of many possible solutions the neurosurgeon has available," Dr. Travis said. "The important thing is to diagnose what is wrong and to develop a treatment plan that works for you."

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