RESUMEN
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.
Asunto(s)
Fijación de Fractura , Osteoporosis , Enfermedades de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral , Columna Vertebral , Anciano , Cementos para Huesos/uso terapéutico , Tornillos Óseos , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Humanos , Osteoporosis/patología , Osteoporosis/fisiopatología , Osteoporosis/cirugía , Selección de Paciente , Ajuste de Riesgo , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/fisiopatología , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/fisiopatología , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Columna Vertebral/patología , Columna Vertebral/fisiopatología , Columna Vertebral/cirugíaRESUMEN
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.