Implications of the Aging Population on Spine Surgery

Peer Reviewed

Commentary by Michael G. Fehlings, MD, PhD and James S. Harrop, MD, FACS

With the global population undergoing an upward shift in its age structure, clinicians are required to manage a growing number of spinal disorders specific to the elderly. In addition, these elderly patients often will present with age-related comorbidities (eg, cardiovascular disease, cancer, diabetes) that will complicate diagnosis and treatment, according to the lead article in a recent supplement in Neurosurgery focused on the aging spine.
Portrait of a Happy Senior Couple Sitting at the Kitchen Table with a Bowl of Fresh Salad, Smiling at the CameraGlobal populations have consistently increased over the past 60 years. Photo Source: populations have consistently increased over the past 60 years with the number of people over the age of 80 years in 2050 expected to be 379 million, a substantial increase from the 69 million estimated to be in the age group in 2000, noted lead author Michael G. Fehlings, MD, PhD, and colleagues.

With this changing population comes an increase in the number of deaths from noncommunicable diseases—such as heart disease, cancer, and diabetes mellitus—as well as an increase in the proportion of the population living with chronic conditions. Currently, approximately 80% of elderly people it the United States have at least 1 chronic condition, and 50% have 2 chronic conditions.

For spine surgeons, this elderly age group poses unique challenges stemming from reduced bone mass density and osteoporosis, decreased mobility, spinal degeneration and deformities, poor balance, and a greater propensity to falls. Age-related spinal disorders that are expected to increase in number are shown in the Table.

Common age-related spinal disorders, table

Focus of the Supplement

The Neurosurgery supplement is divided into the following 5 sections that address a wide range of issues surrounding age-related spinal disorders, including diagnosis, clinical and radiographic presentation, and treatment strategies:

  • Section 1. Spine Trauma in the Elderly: presents specific recommendations for the management of spinal fractures and addresses the optimal timing of surgery for central cord syndrome and best treatment strategies for osteoporotic and odontoid fractures.
  • Section 2. Degenerative Diseases of the Spine in the Elderly: presents optimal management strategies for degenerative cervical myelopathy, lumbar spinal stenosis, and spinal deformity.
  • Section 3. Techniques to Handle the Aging Spine: discusses the evolution of medical management of osteoporosis, surgical treatment of spinal conditions in the osteoporotic spine, and the role of minimally invasive spine surgery.
  • Section 4. Economics and Outcomes Perspective: addresses the cost per quality-adjusted life-years for elderly versus younger patients, and the impact of increased rates of spine surgery in the elderly on access to health care in North America.
  • Section 5. Spinal Deformity: discusses how to weight the risk versus the benefits of correcting spinal deformities in the elderly, including thoracic hyperkyphosis, and the association between movement disorders and spinal deformity.

“Spine disorders develop typically due to increase ‘wear and tear’ on the spine. In that, patients are living longer, the issues of musculoskeletal problems have increased,” said Dr. James S. Harrop, MD, FACS, Professor of the Departments of Neurological and Orthopedic Surgery, and Director of the Division of Spine and Peripheral Nerve Surgery, at Thomas Jefferson University in Philadelphia, PA.

 “In spine, there are 2 major trends: 1) people are living longer, but more importantly, 2) people demand increased activity with the highest quality of life. Thus, spinal procedures will become even more prevalent,” Dr. Harrop noted.

The Neurosurgery supplement “is important since it highlights the issues of the growing population and their specific concerns,” Dr. Harrop said.

Updated on: 12/31/19
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Two-level Corpectomy and Three-level Discectomy Show Similar Outcomes for Cervical Spondylotic Myelopathy
Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
Department of Surgery
University of Toronto

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