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Spine Surgery Considerations in the Aging Population

Teaser: 

Erika Leck, MD, PGY 5,1, Sean D Christie, MD, FRCSC, 2,

1 Department of Surgery (Neurosurgery) Dalhousie University.
2 Vice-Chair and Director of Research Professor, Division of Neurosurgery , Department of Surgery (Neurosurgery), Healthy Populations Institute Flagship Project Co-Lead, Creating Sustainable Health Systems in a Climate Crisis, Dalhousie University.

CLINICAL TOOLS

Abstract: The global population is ageing, and with that there is a concomitant increase in spinal pain and mobility complaints, most related to degenerative changes. It is important to consider how the markers of aging and, specifically, frailty, can overlap with symptoms of spine disease. Although non-operative management should be the initial response, spine surgery in older adults is safe and should be considered as part of a holistic approach for patients with persistent neuropathic pain.
Key Words: Spine Surgery, Elderly, Older Adults, Frailty, Imaging, Spinal Degeneration.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. It is essential to remember that, while degeneration is inevitable, the appearance of symptoms is not and treatment decisions must be based on the clinical presentation, not the images.
2. Our ageing population will lead to an increase in the frequency of spine-related complaints.
3. It is important to consider how the markers of aging and frailty overlap with symptoms of spine disease.
4. The conservative approaches should always be pursued prior to consideration of surgical options.
5. When required, spine surgery in older patients is safe and efficacious, but should involve a healthcare team able to appropriately assess and support the patient and their loved ones.
1. Biological age does not necessarily equate to chronological age.
2. Radiological “abnormalities” become more common with age, but are frequently asymptomatic, order tests that direct care.
3. Combination, non-opioid, pharmacological strategies, with a ‘start low and go slow’ approach are preferred.
4. Tools such as the Clinical Frailty Scale can be helpful in predicting risk and clinical decision making.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, spine, surgery, elderly, older adults, frailty, imaging, spinal degeneration

What Challenges are Involved in Surgery for Elderly Patients?

Teaser: 

Matt Farrah,

Co-founder of Nurses.co.uk, Hailsham, East Sussex, United Kingdom

CLINICAL TOOLS

Abstract: Elderly patients who require surgery are often considered "high-risk" by healthcare providers for many reasons. Most elderly are frail and in poor health. Although outcomes of surgery are improving for elderly patients, experts recommend avoiding procedures if less invasive methods are available.
Key Words: elderly, surgery, high-risk, dementia, assessment.
Elderly patients about to undergo surgery should seek advice to improve their blood glucose levels if diabetic and increase iron levels if anemic.
Elderly patients tend to require more physical rehabilitation compared with their younger counterparts.
Support from family and friends can also help a patient's recovery.
The success rate for geriatric surgery is increasing, especially for those older people who live a healthier, more active lifestyle. With education and patience the risks involved with surgery can be mitigated if not eliminated.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Geriatrics, assessment, dementia, elderly, surgery, high-risk
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Management of Lumbar Radiculopathy Secondary to Lumbar Intervertebral Disc Herniation

Teaser: 

Patrick Thornley, MD, MSc, FRCSC,1, Christopher S. Bailey, MD, MSc, FRCSC,2,

1 London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada.
2 London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada.

CLINICAL TOOLS

Abstract: Lumbar intervertebral disc herniations (IVH) carry a high lifetime prevalence and are the most common cause of sciatica. The vast majority of symptomatic lumbar IVH improve with conservative management though adjuncts such as physiotherapy and epidural steroid injections may play a role in short-term symptom relief. For patients with unresponsive lumbar IVH, discectomy reliably improves symptoms more rapidly than continued conservative care, though there is inconsistent evidence that clinical differences between operative and conservative care are no different at one-year after symptom onset.
Key Words: lumbar radiculopathy, intervertebral disc herniation; lumbar intervertebral disc herniation; lumbar disc herniation; sciatica.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. The natural history of lumbar intervertebral disc herniations causing lumbar radiculopathy is favourable with conservative care in the vast majority of patients.
2. Advanced imaging for patients with lumbar radiculopathy is indicated only in the setting of “red flag” neurologic symptoms or a concerning clinical history for infection, neoplastic or traumatic etiology or the absence of symptom improvement after six-weeks of conservative care.
3. Long-term follow-up demonstrates most patients with lumbar intervertebral disc herniation causing lumbar radiculopathy achieve comparable clinical improvement with surgery or conservative management, with surgery leading to earlier symptom resolution.
4. The high-quality evidence for surgery is weak given the high cross over rate but observational studies show a benefit of surgery after failed non-operative care.
1. The diagnosis is made on the patient’s history including leg dominant pain and confirmed by the physical examination.
2. A combination of a detailed motor and sensory neurologic examination, including supine straight leg raise in addition to cross leg straight leg raise, increases the clinical sensitivity and specificity of a diagnostic examination for lumbar radiculopathy.
3. Analgesics should be used to manage function and not just to reduce pain, taking into account response to the specific analgesic on an individual basis including the known side effect profiles.
4. Microdiscectomy surgery for patients with refractory lumbar radiculopathy lasting greater than four months can lead to a significant reduction in leg pain compared to continued conservative management.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, lumbar radiculopathy, intervertebral disc herniation, lumbar intervertebral disc herniation, Lumbar disc herniation, sciatica