Effects of aging on the spine
Back pain is common and affects almost all people at some time during their lives. Many older individuals have back and neck pain, which is often “nonspecific,” meaning that there is no single, easily identifiable cause. Having back or neck pain can be “part of life.” Once it has been established that there is no serious underlying cause of the pain, the following tips and tricks may help lessen your pain.
Things to avoid:
- improper body mechanics (poor posture and prolonged awkward positions)
- movements that jolt or strain the back
- frequent heavy lifting
- repetitive motions that cause discomfort
Things to do:
- Maintain correct posture.
- Lift objects properly. Bend your knees, not your back; keep your head in line with your straightened back; keep the object close to your body; and do not twist while lifting. Do not attempt to lift objects that are too heavy for you, and ask for help.
- Exercise regularly. Low-impact exercises strengthen the core muscles of your lower back and abdomen.
- Maintain a healthy weight. Depending on your body type, gender, and age, aim to maintain a body mass index between 18 and 25. If you are obese or if you are underweight by body mass index criteria, talk to your health-care provider about ways to bring your body weight back to a healthy range.
- Eat a healthy diet with enough nutrients, minerals, and vitamin D to keep your bones healthy and to prevent bone loss.
- Avoid sitting for prolonged time periods. If your work is done sitting, use proper posture adjust your seating, desk, keyboard, and monitor so that they are at a comfortable height. Get up and walk around whenever you can. Do leg exercises while sitting. Use a lumbar support, particularly if you find yourself slouching while you work.
- Wear comfortable shoes and take them off when you can. Wear sandals or shoes that allow the skin on your feet to stay dry. If you must wear boots for work, change into a lighter pair of shoes or sandals when your workday is over. Treat your feet and ankles kindly. Keep your toe nails clean and trim them regularly, wear a clean pair of socks daily, and use a pumice stone to thin your calluses once a week. If you experience ankle swelling, toe nail fungus, or chronic foot pain, speak with your health-care provider.
- Get enough sleep to allow your spine, the rest of your body, and your mind to recover. Your discs do not have blood vessels to provide them with nutrients. Most of the nutrition of the disc spaces comes from the fluid between the cells generated by the bone and ligaments of the vertebrae. At night, your spinal discs literally expand like little sponges by filling up with fluid and nutrients, so after a good rest, you are taller than when you went to sleep because your discs have expanded overnight. Avoid drinking alcohol or watching television within 90 minutes of going to sleep to make sure you get enough sleep time, including REM (rapid eye movements) and deep sleep. If you wake up frequently at night, wake up with a headache, or feel tired in the morning or if your bed partner tells you that you snore a lot and stop breathing at times, see your health-care provider to get checked out for sleep apnea.
- If you have a tendency to suffer from “the blues” and often feel down and sad without a good reason, you have (or have already been diagnosed with) depression. Speak with your doctor about a referral to a mental health professional for treatment. Back pain and depression often go together. The experts are not sure what causes what: if chronic back pain causes depression, or if depression can lead to back pain. In any case, treating the causes of depression often helps people cope with back pain even if the pain does not entirely resolve.
- If you smoke or use tobacco products, please seriously consider quitting today. Nicotine narrows your small arteries and reduces blood flow and nutrients to the spinal discs, resulting in faster spinal disc degeneration. Tobacco use leads to bone calcium loss, decreases your body’s ability to heal wounds and bones, and may result in osteoporosis. Smoker’s cough may trigger back pain. Tobacco use is expensive, has no health benefits, and has lots of serious associated health risks, some of which affect your bones and your spine.
Bone density problems
Osteopenia and osteoporosis are relatively common in the 50+ healthy population. At first, bone loss is painless. Postmenopausal women are at higher risk for bone density problems than men, but men can have osteoporosis, too. Other health conditions such as low thyroid hormone levels, diabetes, ongoing steroid medication (cortisone) use, low testosterone levels in men, low vitamin D levels, and tobacco addiction are common reasons for impaired bone metabolism.
Advanced bone density deficits (osteopenia and osteoporosis) can cause spine-related pain because of the inability of the bony spine to bear the load of the body and tolerate the additional forces associated with motion and carrying items such as grocery bags. Pain fibers sense the limited weight-bearing capacity of vertebrae with bone density problems. The body tries to repair the problem, but this results in increased degenerative changes such as bone spurs and thickening of the spinal ligaments. A bone density problem can be fixed only when the condition is diagnosed and the underlying cause has been identified.
If osteoporosis remains untreated, vertebral compression fractures can occur, which can be very painful and can lead to spinal deformity. This will require additional treatment such as vertebroplasty or a spinal fusion. Bone density problems usually take years to treat and require medications, vitamins, and other dietary supplements.
To determine whether you have osteoporosis, your doctor will ask you to undergo a DEXA (dual-energy x-ray absorptiometry) scan, which is painless and easy.
Osteoarthritis and degenerative disc disease
As we age, so does our spine. It is quite rare to see a spine imaging study of a person over the age of 30 who has a completely “normal” spine. The reason why I chose a picture of the trunk of an old London Plane tree for this section (see above) is because few people would expect an old tree trunk to look completely smooth and regular. Our spines are not entirely different in that regard. The bone spurs and thickening of ligaments that are seen in virtually every 30+ individual’s imaging studies are “normal” in many cases and are often “asymptomatic,” meaning that they do not cause pain.
Neck and back pain is a very common symptom, however, and health-care providers often request imaging studies when people complain of such pain. These types of studies help to determine whether the pain is caused by osteoarthritis and degenerative changes of the spine (e.g. disc herniations, joint enlargement, ligament thickening, and bone spurs). In some cases, the pain generator is not obvious and cannot be seen on diagnostic imaging studies. It then comes down to the art and science of medicine and the skill of the individual medical provider to correctly identify source of the pain.
Stenosis (from the Greek stenos = narrow) is the medical term for “narrowing” of a canal in an anatomical structure. It is used to describe the narrowing of an artery (as in carotid artery stenosis) as well as the narrowing of either the central spinal canal (central spinal stenosis) or the neural formina (foraminal stenosis). The central spinal canal contains (1) the spinal cord from the upper cervical spine down to about L1 (in most adults) in the lumbar spine and (2) the nerve roots of the cauda equina from L1 (the first lumbar vertebra) down to the sacrum.
Foraminal stenosis, which describes a narrowing of the holes between the vertebrae through which the spinal nerves exit and enter the spine, can sometimes be found in addition to central spinal canal stenosis or by itself (for example, when one of the neural foramina is filled by a disc herniation, and the existing nerve root is pinched).
Lumbar stenosis is a narrowing of the central spinal canal of the lumbar spine. The condition most commonly occurs at L4-5 but can be seen anywhere in the lumbar spine. The narrowing forces all the nerve roots through a small bottleneck, usually at the level of the disc space, meaning that the nerve roots cannot move as freely as they usually do because they are no longer surrounded by enough spinal fluid to glide up and down with every step the person takes. Consequently, walking becomes painful, and people with lumbar stenosis can walk only short distances (about 1/2 to 2 city blocks) before they have to sit down and rest. The pain usually disappears when sitting but returns when walking . This type of symptom is called “neurogenic claudication” and is a relatively common problem in people in their 60s and 70s. Treatment options exist. For some time, nonsurgical treatment may be effective, but eventually, the narrowed spinal canal or neural foramina may need to be opened up surgically. This is referred to by spine surgeons as a “lumbar decompression” and is sometimes combined with a lumbar fusion procedure. In many cases, a decompression procedure is extremely beneficial and will restore the person’s ability to walk farther distances than before.
Normal spines are straight when looking at a person from the front and the back. However, when looking from the side, the normal spine has certain typical curves, which make it better able to bear weight and to withstand the stresses of everyday life. The normal cervical (neck) and lumbar (lower back) spine is bent toward the front of the body. This forward sway of the spine is referred to as cervical and lumbar lordosis (from the Greek lordos = bent backwards). The normal thoracic spine (midback) is gently bent towards the back of the body, which is called kyphosis (from the Greek kuphos = bent, hunchbacked).
Spinal deformities are often seen in children. The deformities arise during fetal or early postnatal development. Many of these deformities are relatively mild, but as a person ages, the curvature often worsens. A mild scoliosis (from the Greek scolios = bent), which is a harmless sideways curvature of the spine, may not present a problem during childhood or early adulthood but may become worse after menopause, as the muscles, ligaments, and bones that support the spine weaken. Vertebral fractures from trauma, osteoarthritis, degenerative disc disease, osteoporosis, loss of muscular strength, poor nutrition, obesity, and a sedentary lifestyle can contribute to worsening spinal deformities in the 50+ adult population. The deformities can become so severe that they make it difficult or impossible to live a normal life. In some cases of mild or early spinal deformity, nonoperative treatment includes regular exercises (initially with the help of a physical therapist), lifestyle changes, bracing, intermittent nonaddictive pain medications, and improvement of reversible conditions like osteoporosis. In cases of severe and disabling spinal deformity, surgery may be helpful but is often fairly extensive and require a prolonged recovery period.
Prior spine surgery
Although patients who undergo spine surgeries may experience pain reduction and restoration of neurological function, there can be long-term effects related either to the condition that led to the surgery and to problems related to the surgery itself. Long-term follow-up after spinal surgery is sometimes advisable, particularly if symptoms persist. The following problems may occur months, years, or even decades later:
- After a spinal fusion either with or without plate, screw, or rod instrumentation, the risk of developing degenerative spine conditions (e.g. osteoarthritis, bone spurs, disc bulges, and disc herniations) at the disc spaces adjacent to the fused spinal disc spaces is increased. In the cervical spine, there is a 2-3% per year chance of requiring a surgery either above or below the fusion.
- After laminectomy or laminotomy decompression, there is an increased long-term risk of developing a spinal deformity, including a vertebral slip (spondylolisthesis), which may require a more extensive spinal surgery to correct.
- Postoperative problems after a spinal fusion include hardware failure (plate, rod, or screw breakage, loosening, or pullout), particularly if a solid fusion did not form after surgery (which is called a malunion or nonunion of fusion).