title: Treating the Aging Spine.
abstract: 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 treated. 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 who have 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 low-demand patients, whereas surgical fixation is favored for high-demand patients. Management of degenerative deformity must address sagittal plane balance, which includes consideration of pelvic incidence. Various osteotomies may prove helpful in this setting.
authors.affiliation: Professor and Vice Chairman, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Choma
authors.forename: Glenn
authors.initials: G
authors.lastname: Rechtine
authors.forename: Robert A
authors.initials: RA
authors.lastname: McGuire
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D001863:Bone Screws; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010024:Osteoporosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D020379:Risk Adjustment; D013122:Spinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013131:Spine / Q000473:pathology / Q000503:physiopathology / Q000601:surgery
chemical_list: D001843:Bone Cements