Treating the Aging Spine.
Demographic trends make it incumbent on orthopaedic spine surgeons to recognize the special challenges involved in caring for older patients with spine pathology. Unique pathologies, such as osteoporosis and degenerative deformities, must be recognized and dealt with. Recent treatment options and recommendations for the medical optimization of bone health include vitamin D and calcium supplementation, diphosphonates, and teriparatide. Optimizing spinal fixation in elderly patients with osteoporosis is critical; cement augmentation of pedicle screws is promising. In the management of geriatric odontoid fractures, nonsurgical support with a collar may be considered for the low-demand patient, whereas surgical fixation is favored for high-demand patients. Management of degenerative deformity must address sagittal plane balance, including consideration of pelvic incidence. Various osteotomies may prove helpful in this setting.
Theodore J
TJ
Choma
Glenn R
GR
Rechtine
Robert A
RA
McGuire
Darrel S
DS
Brodke
D015502:Absorptiometry, Photon; D000375:Aging / Q000502:physiology*; D015519:Bone Density; D005593:Fracture Fixation, Internal; D050815:Fractures, Compression / Q000601:surgery; D006801:Humans; D015596:Nutrition Assessment; D009809:Odontoid Process / Q000293:injuries*; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000628:therapy*; D013121:Spinal Curvatures / Q000628:therapy; D016103:Spinal Fractures / Q000628:therapy*; D013130:Spinal Stenosis / Q000601:surgery*; D013131:Spine / Q000503:physiopathology / Q000601:surgery
aging spine; odontoid fracture; osteoporosis; spinal deformity; spinal fixation