Physiological changes of old age
The relentless, unstoppable process of aging gradually affects all structural elements of the spine. The degenerative process starts in the intervertebral disc in the first decade of life. In the beginning, this process of attrition is the cause of biochemical changes manifested first in microscopic then, later, in macroscopic changes, fractures and tears in the disc wall followed, possibly, by the most prevalent cause of nerve disorders in the young adults, the herniated discs.
Along with the above, pain transmitting nerve fibers may appear in the degenerating intervertebral disc, causing lumbar pain. Partly as a result, following the disc's degeneration, abnormalities usually appear in the joints (facet joints) connecting the vertebrae to each other. This may be manifested in facet joint displacement (i.e., subluxation, spondylolisthesis), osteoarthritis of the joints and joint arthrosis. The increased size of the facet joint, caused by deposits, its slackness and the intervertebral disc's degeneration together with the thickening of the ligaments joining the bones, increasingly narrow the nerve's pathway, causing narrowing of the spinal canal (spinal canal stenosis).
Degeneration of the structures mentioned above, may cause some segments of the spine to shift abnormally, altering, over the years, the shape of the spine, deforming it and resulting in scoliosis. They are the most frequent causes of neural diseases, walking difficulties, pain in the lower extremities and functional problems in the elderly.
The vertebral body is the static element of the spine's structure. As we age, osteoporosis weakens the bony structure of the body, escalating bone remodeling, speeding up changes in its shape and form and causing such deformities as the increased curvature of the upper spine (hyperkyphosis).
The aging intervertebral discs, facet joints, ligaments and musculature lead, in the end, to destabilization causing the destruction of the functional equilibrium of the body.
The effect of inter-relating changes in the anatomical structural elements of the human spine affect many levels: the bone, the intervertebral discs, the facet joints and the ligaments. A Herniated disc or the narrowing of the spinal canal developed as the result of degeneration may also cause damage to the neural and functional structures. Due to the aging population, the number of patients suffering from osteoporosis is growing.
Among the most frequent complaints among the elderly is lumbar and cervical pain. The nature of the spine, however, makes their examination and treatment quite difficult.
The human spine is, both anatomically and functionally, a very special structure. While radiologic examinations show that not every older patient suffers degeneration of the knees or hips, just about all of these patients are shown to have degeneration of the spine and while only a few patients with significant knee or hip degeneration are complaint free, many patients suffering from severe spine degeneration have no complaints. A complaint free patient's future complaints, or its severity, cannot be predicted by the degeneration shown on a current MRI scan.
As seen from the above, the same abnormalities of the spine befall the young as the old with the difference found not in the differing abnormalities but in that they appear jointly, together, affecting each structural element of the spine at once. This fact is usually observed on every segment of the spine examined.
As long as there is no urgent indication for surgery (i.e., signs of possible damage to the spinal nerve), the initial treatment, in every case, is rheumatological with conservative musculoskeletal treatments consisting mainly of physical activity even for the elderly, since spine exercises have been shown to have very good therapeutic effects.
The special difficulty in treating abnormalities of the spine in the elderly, is identifying among the many existing degenerative conditions, the leading causes of the complaints and separating them from those causing none or very minimal complaints. This is also of primary concern since, due to the patient's age and general health condition, we must strive to set up a surgical procedure causing the least possible amount of stress and strain on the patient while, at the same time, providing the greatest improvement in the quality of life. Any accompanying illnesses (i.e., high blood pressure, diabetes, cardiovascular diseases, pulmonary disease, etc.) must also be taken into account. It is a sad fact that, in numerous cases, the extent and gravity of the osteoporosis, the patients' general health and weakened bones make surgery impossible.
The rising average age of the population of developed industrial countries is a continual observable process. The increased life span - due, in a large part, to the developments in health care as well as the drastically reduced number of births have jointly created this phenomenon shifting world demographics from a high birth rate and early death to that of a low birth rate and later death. In Europe, in 1950, 10.8% of the population was over the age of 65, in 1955, it was 19.1% and by 2025, it is expected to be 30.1%.
The complexity and the many factors surrounding spine degeneration, the variety of treatments available and the rapid development of medical technology along with the patients' increasing expectation of a better quality of life have caused the cost of treatment to increase worldwide.
New technology is being developed that attempt to influence the degeneration process itself. One of these that emerge above the rest is the molecular biological version that international researchers are focusing on and that we are involved with, as well. These procedures show great promise for the future.