Spinal Diseases in the Elderly

Spinal Diseases in the Elderly

The majority of spinal fractures (70%) occur in the dorsal and lumbar vertebrae. Spinal fractures may develop due to accidents and traumas, as well as manifest themselves as osteoporosis or "stress fractures". The most frequently injured area is the 12th dorsal and 1st lumbar vertebrae, where the dorsal and lumbar vertebrae meet, which is the most mobile region of the spine.

In How Many Ways Can Spinal Fractures Occur?

If too much load is placed on a bone, the bone breaks. The most common type of fracture is "compression fractures", in which the anterior portion of the vertebrae collapses. If the load on the spine increases even more, then the middle and posterior parts of the vertebrae are also broken and the broken pieces may move towards the spinal canal and injure the spinal cord. This type of fracture is called a blast fracture. Spinal cord injury and paralysis are common in burst fractures.
If the loads on the spine increase even more, then with the fracture in the bone, there may be injury in the discs, ligaments and joints that hold the vertebrae together, and spinal dislocation by breaking the connection of the two vertebrae with each other. may occur. This condition is called fracture dislocation. This type of fracture is usually accompanied by spinal cord injury. At the same time, these types of fractures are more difficult to heal, and fracture-dislocations usually require surgical treatment.

What are the Symptoms of Spinal Fractures?

The early symptoms of spinal fractures are usually neck, back and low back pain and muscle spasm. manifests itself. If spinal cord injury also accompanies the fracture, there may be various complaints such as numbness, numbness in the arms and legs, loss of strength, urinary incontinence or inability to make bowel movements. The late-term symptom is kyphosis (humpback) in the spine and associated back and low back pain if adequate treatment is not applied in patients without nerve injury. In case of nerve injury, sensory loss and paralysis can be counted as late symptoms.

What are the Causes of Spinal Fractures?

Spinal fractures mostly occur in young people with high-energy traumas such as falling from a height or traffic accidents. In the elderly, vertebral fractures may occur with simple traumas or even without trauma due to osteoporosis.

Age In patients with spinal fractures due to osteoporosis, there is usually a history of low back pain that develops suddenly and is not accompanied by a trauma. The pain increases when standing or walking and decreases when lying down and resting. In untreated patients, spinal movements are restricted, bone height loss occurs and pain may not go away. In cases where collapse progresses, neurological findings that may lead to paralysis may occur. Failure to carry the patient in an appropriate position is one of the most important factors affecting the fate of the injury. Patients brought to the emergency department should be carefully evaluated in terms of accompanying organ injuries, fractures of other regions, and head trauma.

Who is Most Affected by Spinal Fractures?

80% of patients with spinal fractures They are people between the ages of 18-50. Men are 4 times more likely to have a spinal fracture than women.

What are the Treatment Principles of Spinal Fractures?

Treatment of spinal injuries depends on the type of injury and whether there is spinal cord damage. The aim of the treatment can be summarized as obtaining a spine that will not be damaged by normal physiological loads and returning the patients to their previous activities painlessly in a short time. Patients with collapsed anterior vertebrae and unaffected soft tissues connecting bones can be treated with bed rest and a corset. Patients can return to their daily work in a corset in about 10 days. The duration of wearing the corset varies between three and six months.

If the injury has caused an unstable fracture or fracture-dislocation, has caused or has the risk of creating spinal cord damage, surgical methods are preferred for treatment. In surgical treatment, restoration of the integrity of the vertebrae is usually achieved with screws and rods applied from the back. The placement of these rods can also be performed with closed methods in suitable patients, thus minimizing postoperative pain and hospital stay. If there is a risk of nerve damage or injury, the relaxation process called decompression is added to the treatment during surgery. .

Vertebroplasty or kyphoplasty method is preferred for compression fractures caused by osteoporosis. In the vertebroplasty method, bone cement is sent into the vertebrae to relieve pain while preventing the progression of collapse. In the kyphoplasty method, the collapse of the vertebrae is corrected with a balloon before the cement application. In two methods, it is applied in our center, accompanied by radiological imaging called scopy and closed (without skin incision). In this method, collapse is corrected with closed cages placed inside the vertebrae. Patients treated in this way can return to their previous work and activities in a short time and painlessly.

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