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KMID : 1150320060020010107
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Journal of Korean Society of Geriatric Neurosurgery
2006 Volume.2 No. 1 p.107 ~ p.138
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Management of Spinal Pain in Geriatric Patients
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Park Jung-Yul
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Abstract
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Before Proper management of spinal pain in elderly patients can be planned, every effort should be made to contemplate all possible factors that might have played roles in generating such pain. This may be owe to different pathophysiologic mechanisms may act upon aged apine and surrounding structrues. Thus, diagnosis should not be frawn until full history taking, careful physical and neurological evaluation, and verification of relevant pathologic conditions with varioys modem strudying tools. Also, factors such as psychosocial and socioeconomic status may be important issues to consider in these patients. Pain from spinal origin in aged subpopulation is relatively common and comprise of various pan syndromes originating from vertebral bodies. joints, muscles, and other soft tissues. Althoygh the causes of this type of pain in elderly disc. spinal stenosis, spondylolisthesis, compression fracture related to osteoporosis, and pain originaling from zygapophysial joints and other surrounding structures. Less common but other imprtant causes in such patients include metastatic lesions, infection, and myofacical pain syndromes. Here, evidence-based lierature review withe personal experience on common disorders affecting elderly patients causing pain of spinal origin is presented with special attention focused on minimally invasive therapeutic approaches based on pathophysiologic processes and clinical presentations.Ilowever, whichever treatment chosen it should have been decided based upon the clinical presentations that are closely correlated with definitive findings from studies best available whenever possible. Also, it should be born in mind that structural abnormaltiies seen in imaging study are ofien quite different from the major causative factors responsible for clinical symptoms and signs in elderly patients. Recent studies have indicated the importance of biochemical or neurohumoral factors for generation of persistent neurological symptoms and signs that may account the dorrinant compoenent of clinical findings. Thus, proper treatments based on these pathophysiological mechanisms should be sought and carefully planned.
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KEYWORD
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Aged, Spinal pain, Degeneration, Diagnosis, Management
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