2 Common Spinal Conditions in Seniors and the Elderly

Believe it or not, by 2056 there will be more senior citizens than kids according to the U.S. Census. Truly, the aging population is on the rise. The Census also estimates that by 2029 the over-65 crowd will comprise 20% of the total population.

And as we age, so do our spines. While there are a number of possible back conditions that you or your loved ones may encounter, the more common of these are usually related to osteoporosis and degenerative changes that affect discs and other structures.

Spinal Fractures

If you're female and over 70, you may know the pain and inconvenience of an osteoporotic fracture. Common among baby boomers and older generations, an osteoporosis-related spinal (or ​other types of) fracture can result in constant, nagging back pain. The discomfort may affect your daily activities and have a negative impact on your emotions or relationships.​

Vertebral fractures are the most common type of osteoporotic fractures. Sometimes the back pain that results from a vertebral fracture mimics symptoms of other diseases or conditions. This is why diagnostic imaging is important. Tests like X-rays, MRIs, or CT scans can help evaluate compression and wedge fractures. Bone biopsies are also used to confirm osteoporosis.

Osteoporosis is a bone disease that affects post-menopausal women in particular. When you have osteoporosis, your bone mass decreases faster than it can be built back up. Bone mass is made up of protein, as well as the minerals calcium and phosphorous.

Fractures due to osteoporosis can occur after trauma, but they can also come about with no apparent cause.

The good news, though, is that many cases of vertebral compression fractures (the most common type) improve within 3 months without any treatment at all, according to the American Academy of Orthopedic Surgeons. The Academy suggests taking simple measures while you're healing, such as limited use of pain medications and taking time to rest as needed. Your healthcare provider may prescribe a brace for you to wear, as well.

Surgery for Spinal Fractures

About one-quarter of osteoporosis fracture cases don't respond well to conservative care, such as physical therapy, medication, or simply waiting it out. So if your pain is severe and it doesn't get better with conservative measures, it may then be time to consider surgery. Discuss your options with your healthcare provider to be sure.

Two types of procedures are commonly used to surgically treat spinal fractures: vertebroplasty and kyphoplasty. Both are minimally invasive and will likely allow you to recover relatively quickly and easily. They involve injecting cement into your bone to help mend it, and in some cases, to restore the height of the vertebra.

Hyperkyphosis

Vertebral fractures often lead to a posture condition called hyperkyphosis, also known as age-related hyperkyphosis. While hyperkyphosis can be caused by a number of things about a third of the time, they are a result of spinal fractures in the elderly population. As the name suggests, hyperkyphosis is a deformity in which the normal kyphotic curve in the thoracic spine (located in your upper and mid-back areas) becomes excessive or exaggerated.

Disc Degeneration

Degeneration of spinal structures is somewhat inevitable as we age. It can occur in any of the structures that make up your back, including the discs, bones, joints, ligaments, muscles, nerves and more. Most of the time, non-surgical treatment can relieve the pain in your back and increase your physical functioning.

Sometimes, though, conservative methods fail and your healthcare provider may suggest surgery. This is especially true if you have severe and/or unrelenting pain or your pain is due to radiculopathy (symptoms such as sciatica that are caused by an irritated spinal nerve root) or myelopathy (symptoms caused by disruption or compression to the spinal cord).

Degeneration in spinal discs is the most common type of spinal degeneration and often the first type to develop. Degenerating spinal discs can lead to degenerative changes in other parts of the spine, as well.

Disc degeneration is not technically a spinal disease, but rather a description of the condition of these shock-absorbing "pillows." According to the Arthritis Foundation, nearly everyone over the age of 60 has at least some disc degeneration (as shown by MRIs.) But not all will feel pain.

Should the discs collapse completely, the Arthritis Foundation continues, the facet joints at the back of the spine may begin to rub against each other, leading to symptoms of osteoarthritis, mainly pain, and stiffness.

Things that cause disc degeneration include the inevitable drying that comes with age. Drying decreases the disc's ability to absorb shock. Discs have little to no blood supply, which means once they've been damaged, healing is difficult at best. This limited healing capacity of the discs is often what starts and/or perpetuates the deterioration process that leads to spinal degeneration.

Perhaps the most common cause of chronic low back pain, disc degeneration can take a number of forms. Most of the time, internal disc disruption (IDD) is at the root of the problem. Internal disc disruption is another name for annular tear injuries, the collapse of the disc and/or mechanical failure of the disc, with no accompanying changes to the shape of the disc (as viewed from the outside) and no changes to the vertebral endplate. IDD is a clinical entity all its own. In other words, it is not the same as degenerative disc disease or herniated disc.

Discogenic pain is the name given to the pain resulting from IDD.

Symptoms of Degenerating Discs

Symptoms of degenerating discs tend to occur where the damage is located. Symptoms can include pain (mild to severe) that worsens when you sit, lift, bend, or twist. The pain may come and go and may get better when you move your body. Numbness, tingling and/or leg weakness (in the case of lumbar disc degeneration) that accompany the pain can indicate damage to one or more spinal nerve roots.

Healthcare providers divide up the types of pain related to spinal degeneration into 4 categories. Axial pain is pain that occurs in and around the spinal column. Radiculopathy is pain and other symptoms that arise from an irritated spinal nerve root. Myelopathy refers to pain and other symptoms related to damage to the spinal cord (examples of myelopathy symptoms include coordination or gait issues, and possible bowel or bladder problems). Myelopathy symptoms tend to be more serious in nature than symptoms that are related to radiculopathy or those that are limited to the axial spine.

Degenerative disc disease (DDD) is pain related strictly to the disc and nothing else. It is diagnosed when your healthcare provider cannot find any reason, other than the disc itself, to explain the presence of your pain. To arrive at the DDD diagnosis (as well as the diagnosis for many other types of spinal problems) your healthcare provider will likely use medical history, a physical exam and possibly MRI. Other tests that help confirm your healthcare provider's suspicions may include X-ray and/or provocation discography.

Treatment for Degenerating Discs

As far as treatment goes, generally conservative care is enough to abate the symptoms. Conservative care usually consists of physical therapy, at-home exercise program, staying active within tolerable limits, pain medication and possibly spinal injections. Only rarely is surgery indicated to treat isolated axial low back pain resulting from DD, since surgery for low back pain has a low rate of success.

Along with pain reduction, the success of treatment for degenerating discs is measured by your ability to function in your daily life—things like being able to walk, stand, sit and lift objects without pain, being able to engage in social life with minimal restriction, traveling comfortably and more speak volumes as to how well you are managing and/or healing from degenerative changes in your discs.

Spinal Arthritis and Spinal Stenosis

Disc degeneration often leads to osteoarthritis in the joints that are located at the back of the spine (facet joints.) Along with hypertrophy and the formation of spurs, the bone-on-bone contact that results from changes in spinal alignment due to disc collapse can cause pain and inflammation in the facets. The abnormal bone growth (facet joint hypertrophy) changes the shape of your vertebrae and can encroach on the spaces and holes that are in and around the spinal column. When this happens, the spinal cord and/or the spinal nerve roots may become irritated as they come into contact with the spurs.

Osteoarthritis is a progressive disease, but you can help slow it down by working earnestly with your healthcare provider and physical therapist. The exercises they give you to do at home are particularly important for managing the rate of progression. Most likely, they'll recommend flexibility development, muscle strengthening and no- or low-load exercise such as aquatics.

But when the disease worsens it may lead to spinal stenosis. Spinal stenosis is a narrowing of the spaces through which nerves and the cord travel, namely the spinal canal and the intervertebral foramen. Two types of stenosis in the spine are the central canal and foraminal stenosis.

The classic symptom of spinal stenosis is neurogenic claudication which is a pain on walking and standing, which tends to be relieved when you sit or lie down. Other symptoms include radiculopathy or pain and nerve symptoms that affect one arm or leg and thickened ligaments. Thickened spinal ligaments, especial the ligament flavum, may add to the encroachment factor, thereby adding to the irritation to your spinal nerve root and/or spinal cord.

As with many other types of degenerative spine conditions, pain relief and increased functioning can generally be achieved with conservative care. Your healthcare provider may prescribe physical therapy and anti-inflammatory medication. Should symptoms persist, she may refer you to a surgeon for a decompression. The purpose of a decompression back surgery is to enlarge the encroached spaces. It is said that this back procedure helps people walk farther and stand for longer periods of time with minimal discomfort. If your spine is unstable, your surgeon may also fuse the area. This may involve either taking bone from your pelvis and putting it in your spine or implantation of metal pieces such as screws and rods.