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The Aging Spine: Challenges and Care in Trauma Management

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Summary

This informative on-demand teaching session, which is the third in a series focused on Elderly Trauma, will delve deeply into the complexities of spinal injuries in the elderly. Aimed at medical professionals, this lecture will sensitize you on the increasing frequency of spinal injuries among the elderly, with up to 30% of cases found in patients over 65 years, predominantly due to falls. You will learn about the challenges these patients face due to age-related changes like osteoporosis and the subtle but important signs of spinal injuries. Additionally, you'll get insights into the diagnostic tools, current treatment methodologies, and rehabilitation strategies best suited for these situations. Understanding these concepts can significantly improve your clinical acumen, enabling you to optimize patient outcomes even when challenged by this difficult diagnosis. You will also delve into review case studies for further learning. Don't miss out on this enlightening session; register today!

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Description

will delve into the unique challenges associated with managing spine trauma in older adults. This lecture will explore the physiological changes in the aging spine that contribute to higher risks of fractures and complications, highlighting common mechanisms of injury and their impact on diagnosis. Key topics will include the importance of early detection, imaging strategies, and evidence-based management protocols. Attendees will gain insights into comprehensive care approaches, from conservative treatment options to surgical interventions, with a focus on minimizing morbidity and promoting recovery. The session will also touch on the implications for rehabilitation and long-term patient outcomes, emphasizing multidisciplinary collaboration to optimize care for elderly patients.

Learning objectives

  1. To understand the physiology and anatomical changes that occur in an aging spine and how this impacts the increased risk of spinal injuries in the elderly population.
  2. To identify the most common causes of spinal injuries in the elderly and recognize the typical clinical presentations associated with these traumas.
  3. To comprehend the challenges in diagnosing spinal injuries in the elderly population, comparing and contrasting various diagnostic tools including X-rays, CT scans, and MRIs.
  4. To learn and comprehend the various conservative and surgical management methods for addressing spinal injuries in elderly patients, including the importance of effective pain management strategy.
  5. To grasp the significant role that early intervention and rehabilitation play in improving the prognosis of elderly patients with spinal injuries, and understand the contribution of a multidisciplinary team in this process.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Everyone. Welcome to the third lecture in our Elderly trauma series. Today, we'll be focusing on spinal injuries in the elderly. A topic that's often challenging due to the unique anatomy and physiological changes that occur with my name is, and I'll be guiding you through the key aspects of spinal trauma in older aos spinal injuries are increasingly common in the elderly. Accounting for up to 30% of cases in patients over 65 the most frequent causes falls responsible for around 60% of these injuries. Other causes include motor vehicle accidents and low velocity trauma. What makes this age group especially vulnerable is the age related changes in their musculoskeletal system, particularly osteoporosis and degenerative joint disease. Elderly patients are more susceptible to spinal injuries primarily because of osteoporosis which significantly weakens bones, making them more prone to fractures. In addition, age related degeneration including loss of intervertebral disc height and reduced flexibility, makes the spine more fragile, combines with the higher incidence of due to balance problems. And it becomes clear why this population is at such high risk. The most common types of spinal injuries in the elderly involve the cervical spine, including odontoid fractures and conto injuries, thoracolumbar fractures, often compression fractures or burst fractures are also prevalent. And I must not forget the risk of spinal cord injuries particularly following cervical trauma, which can have devastating consequences in older adults. And the clinical presentation of spinal injuries in the elderly can be quite subtle, often involving only mild pain which is easily mistaken for chronic musculoskeletal pain due to decreased pain sensitivity. In this age group. Many elderly patients present late. It's essential to maintain a high index of suspicion, especially in patients with known osteoporosis or a history of frequent fall. One of the major challenges in diagnosing spinal injuries in the elderly is that nonspecific back pain is incredibly common and often ignored. Additionally, pre existing spinal degeneration makes imaging interpretation more difficult. This is where our diagnostic tools including X ray each and play a critical role in differentiating between old and new injuries. X rays are often the first imaging to use, but they have limited sensitivity especially when it comes to subtle fractures. CT scans are far better for evo injuries and fractures. While myths are crucial for assessing soft tissue injuries and spinal cord involvement, especially in cases of suspected spinal cord compression, cervical spine injuries carry a high morbidity risk in elderly patients, particularly the prevalence of odontoid fractures and contoid fractures and conduit management can be challenging, especially when it comes to immobilization. As traditional colors may not be suitable for frail patients and over immobilization can lead to complications like pressure ulcer in the thoracolumbar spine. The most common injury in elderly patients is compression fractures usually related to osteoporosis, vast fractures while less common or more severe and occur from high energy trauma. These fractures pose a significant risk for spinal cord compression, potentially leading to neurological deficits. Spinal cord injuries in the elderly are associated with high mortality and worse outcomes compared to younger patients. These injuries often occur following cervical trauma and complications such as quadriplegia and respiratory failure are common due to the increased fragility of the spinal cord structure. Conservative management is often indicated for stable fractures, particularly in patients with significant comorbidities, pain management through analgesia and early physio is crucial, prolonged immobilization should be avoided where possible as it increases the risk of complications such as pneumonia and pressure. So, surgical management is typically reserved for unstable fractures or cases where there is spinal cord compression. However, surgery in the elderly comes with its own challenges due to frailty and multiple comorbidities which increase the risk of perioperative complications. Despite this surgery can improve function and reduce pain in certain cases, but the decision must be carefully weighed. Effective pain management is essential in treating spinal injuries in the elderly. Pharmacological options include analgesics and nerve blocks which can provide localized pain relief. Non pharmacological approaches such as physiotherapy and proper positioning are also crucial. A multidisciplinary approach involving pain specialists and rehabilitation teams helps optimize pain control and recovery, immobility for spinal injury significantly increases the risk of complications such as pressure, ulcers, pneumonia, and thromboembolism including deep vein thrombosis and pulmonary embolism. Long term, many elderly patients suffer from a loss of independence and reduced quality of life. Making early intervention and rehabilitation, vital rehabilitation should begin as early as possible. With early mobilization being key to preventing complications and promoting recovery. Physiotherapy plays a major role in helping patients regain strength and mobility. While occupational therapy and social services work together to ensure a smooth transition back to daily living. The prognosis of spinal injuries in the elderly is generally poor with a mortality rate. 34 times higher than in younger patients. Functional outcomes are often suboptimal with many experiencing a permanent reduction in mobility. However, early intervention, both in terms of medical and surgical management can significantly improve survival rates and quality of life. Let's take a look at a case study missus, a 78 year old woman presented after a fall at home, complaining of severe back pain, imaging revealed a compression fracture at two, given her comorbidities and stable condition. We opted for conservative management with physiotherapy and being controlled. She showed gradual improvement over the following week. Managing spinal injuries in the elderly requires a multidisciplinary approach. Geriatricians provide essential input regarding comorbidities and overall care. While physiotherapists focus on rehabilitation and mobilization, surgeons are involved when necessary, particularly for unstable fractures or spinal cord compression. According to nice guidelines. Early intervention is critical and proper risk stratification helps guide the treatment approach. Spine's recommendations focus on maintaining spinal stability and preserving neurological function. Best practices emphasize multidisciplinary care and early mobilization to optimize patient outcomes. In conclusion of spinal injuries in the elderly present unique challenges due to fragility and the difficulty of diagnosis. A multidisciplinary approach is essential for optimizing outcomes and early intervention, whether conservative or surgical makes a significant difference. Thank you for your attention. I am happy to take any questions you may have.