Spinal Deformities Associated with Aging
With aging, various spinal deformities can develop due to the wear and tear of the spine, calcifications, and often spinal canal stenosis. These may sometimes be related to rheumatologic diseases or arise as a result of improperly performed surgeries, leading to the loss of the spine’s normal physiological curvatures.
Types of Deformities in Elderly Patients:
- Coronal Plane Deformities: These refer to the side-to-side curvature of the spine when viewed from the front, where the spine should ideally appear as a straight line.
- Sagittal Plane Deformities: These refer to the loss of normal curvatures when viewed from the side, often causing the patient to lean forward.
Examples of coronal plane deformities include scoliosis in elderly patients, while sagittal plane deformities can include flat back syndrome due to improper surgeries, aging, spinal canal stenosis, or forward spinal bending from rheumatologic diseases.
When to Consider Surgery for Deformities
Regardless of the cause, if these deformities negatively impact the patient’s daily life, make it difficult to look ahead, require significant energy for the patient to maintain an upright posture while walking, or prevent the patient from standing upright, surgical correction of the deformity should be considered.
Challenges in Spinal Deformity Surgery for Elderly Patients
Spinal deformity surgeries in elderly patients pose numerous challenges, primarily due to comorbidities, osteoporosis, and obesity, which can negatively affect surgical outcomes. In patients over 65, these comorbidities and osteoporosis should be thoroughly analyzed, and the most suitable surgical technique and medical treatment should be determined.
Goals and Planning in Deformity Surgery
The main goal of deformity surgery is to restore or achieve angles as close as possible to the patient’s original physiological spinal curvature. Each individual’s lumbar curvature is unique. Similar to fingerprints, the required degree of lumbar curvature for each patient is determined by a radiological parameter known as pelvic incidence. This measurement must be calculated before performing any deformity surgery.
Technical Considerations
After determining the lumbar curvature angle in elderly patients, bone-cutting procedures known as osteotomies may be necessary during surgery to relax the spine. These procedures should be performed by experienced spinal surgeons in hospitals with intensive care units, as longer surgical durations and significant blood loss in elderly patients can lead to serious complications. Poor planning and incorrect techniques increase the need for revision surgeries.
Postoperative Support and Complications
Patients with poor bone quality require the use of cement-augmented screws and post-surgery medical support under the supervision of endocrinology and geriatric specialists. Proper planning and surgeries conducted by experienced spinal surgeons can significantly improve patients’ quality of life within a year following deformity surgery.
Potential Complications After Adult Deformity Surgeries
In surgeries involving multiple spinal levels, particularly in patients over 65, proximal junctional kyphosis (PJK) can occur, which is an increase in curvature or loosening of the screw just above the top instrumented vertebra. This complication, which varies based on the patient's bone quality and the extent of correction, can occur in approximately 20% of patients. Additionally, non-union issues, infections, neurological deficits, and wound complications are among the other frequently encountered postoperative issues.