Spinehealth and Disease
The Aging Spine
The rapidly growing baby boomer portion of the population poses numerous challenges to the healthcare system. This includes the field of spine care. Degenerative changes involving the spine are present to varying degrees in all elderly individuals. As individuals get older, their bodies go through many age-related changes including the spine. It is a natural process that is influenced by lifestyle and healthcare. The
spine is no different than any other area of the body as it ages; it
undergoes changes associated with genetic and environmental influences.
The
Census Bureau projects that the number of individuals 65 years of age
and older will double from approximately 33 million to 65 million in
the year 2030, placing a greater demand on the healthcare system and
individual physicians. There
will be a greater prevalence of cognitive disorders, physical disabling
conditions, urinary incontinence, insomnia and back-related problems. Spinal stenosis and osteoporosis of the spine are already costly dilemmas.
The
genetic makeup of the tissues of the spine, postural habits, work
responsibilities, level of physical activity and body weight all
influence the age-related process. Some
of the more common age-related degenerative conditions that afflict the
spine include osteoporosis, osteoporotic compression fractures,
degenerative joint disease (facet arthropathy), spinal stenosis,
degenerative disc disease, adult-acquired scoliosis and degenerative
spondylolithesis.
As
the spine ages, the bones, ligaments and intervertebral discs undergo
degenerative changes. The vertebrae lose calcium content. The intervertebral discs become progressively dehydrated subsequently become thinner and stiffer. Ligaments of the spine become thinner and less resilient to stress placed upon them. Age-related degenerative changes of the spine often first become evident during the third decade.
Degenerative disc changes associated with loss of disc height and flexibility contribute abnormal movement between vertebral segments. Degenerative changes can result in an increase in vertebral mobility from tears in the supportive ligaments or degeneration can create a loss of mobility. Increased mobility is termed segmental hypermobility or instability and loss of mobility is termed hypomobility or fixation. In the later stages of spinal degeneration, ankylosis or complete bony fusion of adjoining segments may occasionally occur. With advanced degeneration, soft tissues of the spine are at risk for disruption, which can lead to disc herniation, compression fractures and ligamentous discontinuity. When the soft tissues of the spine are unable to maintain spinal stability or bony alignment, vertebral slippage or listhesis can develop.
Spinal degeneration is an inevitable part of the aging process for most individuals. It
may be associated with intermittent and/or persistent signs and/or
symptoms. For some, it will significantly compromise the quality of
their life and diminish their ability to adequately perform activities
of daily living. A
growing body of evidence shows that maintaining an active lifestyle,
improving posture and exercising on a regular basis can be very helpful
in reducing the symptom presentation associated with age-related
degenerative changes. Spinal tissues remodel and repair in response to stresses placed upon them. Subsequently, efficient posture and regular exercise positively impact the tissue remodeling and conditioning process.
There
is an interrelationship between aging, degeneration and deconditioning,
however, they are not one and the same. The spine specialist may find
the distinguishing features between deconditioning, degeneration, and
aging somewhat challenging. The
spine specialist may become preoccupied with the disease state and
overlook the problems related to aging and deconditioning.
The benefits of exercise for age-related muscle atrophy are well documented. The active individual can the slow the aging process and often reduce back pain-related syndromes.
For
some elderly people, a severe declination of motor or muscle function
results in institutionalization and the loss of independence. There
are other disease processes commonly associated with ageing such
osteoporosis, cardiovascular, and osteoarthritis, which further
contribute to degeneration of the spine in elderly decline. Because
of the rapid growth of the ageing population there will be an increased
demand placed on spine specialists for recognizing, preventing, and
treating age-related disorders.