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 spondylolisthesis.
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 to 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.
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