Spinal Injuries of the Elderly
With this chapter, we aim to provide an up-to-date review of the relevant considerations for spinal neurosurgeons involved with the management of an elderly individual following traumatic injury to the spine. The first two sections focus on the features o
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Christopher D. Witiw, Laureen D. Hachem, and Michael G. Fehlings
14.1 Introduction Presently, we are in the midst of a global demographic transition. Worldwide, average life expectancy has increased from 46.5 years in 1950 to 66.0 in the year 2000 and is thought to reach 76 years by 2045. The number of people aged 65 years or older is projected to increase by 140 % between 2006 and 2030 [1], and the “oldest old” (aged 85 years or older) is projected to increase 151 % over this period [2]. This general demographic transition is being translated into an observed shift in age patterns for individuals with traumatic spinal injuries. The mean age at injury has increased nearly 10 years between the 1970s and 2000s, and this has led to a substantial change in the practice patterns of spinal neurosurgeons [3]. The aged population is at a greater risk of sustaining traumatic injury to the spine than their younger counterparts. The reasons are multifactorial. Sensorineural function declines with age. Reduced vision and hearing contribute to a diminished C.D. Witiw, MD Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada e-mail: [email protected] L.D. Hachem Faculty of Medicine, University of Toronto, Toronto, ON, Canada e-mail: [email protected] M.G. Fehlings, MD, PhD, FRCSC, FACS (*) Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada Head Spinal Program, McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 4WW-449, Toronto, ON, Canada M5T 2S8 Department of Surgery, Halbert Chair in Neural Repair and Regeneration, University of Toronto, Toronto, ON, Canada e-mail: [email protected] © Springer International Publishing Switzerland 2017 M. Berhouma, P. Krolak-Salmon (eds.), Brain and Spine Surgery in the Elderly, DOI 10.1007/978-3-319-40232-1_14
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ability to recognize and avoid environmental hazards. Furthermore, impaired balance and gait, compounded by reduced strength and flexibility, place elderly individuals at risk for falls. While more likely to be involved in a trauma, older individuals are also at higher risk of injury. Underlying degenerative spinal stenosis and osteoporosis of the vertebrae place the spinal cord at higher risk of compressive forces from the surrounding osteoligamentous structures of the spinal column. The prognosis following a spinal injury is also lessened with age. Decline in physiological reserve may be further exacerbated by coexisting medical conditions and polypharmacy. Synergistic relations between all of these factors make management of traumatic spinal cord injury (SCI) in the elderly a particular challenge. With this chapter, we aim to provide an up-to-date review of the relevant considerations for spinal neurosurgeons involved with the management of an elderly individual following traumatic injury to the spine. The first two sections focus on the features of traumatic injury and
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