BookFu, Kai-Ming G.; Dimar II, John R.; Mummaneni, Praveen V.; Virk, Michael S.; Wang, Michael Y.
Summary: As the population continues to age worldwide, spinal disease will become more prevalent in the elderly population. The treatment of spinal disease requires an individual approach encorporating best practices. Optimal management in the elderly may differ from younger patients due to increased comorbidities, decreased bone health, and a higher risk of perioperative morbidity and mortality. While more and more elderly patients will require evaluation and management of their spinal disease, most modern books discuss operative and nonoperative management based upon disease process. Techniques and approaches are described for a specific pathology, and are usually tailored for a young or middle aged patient. Treatment of Spine Disease in the Elderly: Cutting Edge Techniques and Technologies is designed to address this gap in today's literature by expressly addressing spinal conditions in the elderly and current advanced techniques and technologies for treating their spinal disease. It will be intended as a resource for the beginning to the advanced surgeon and practitioner whom undertakes treatment of patients in this age group. .
Contents:
Intro
Foreword
Elderly Specific Considerations in Spine Disease
Trauma
Tumor
Adult Deformity
Osteoporosis
References
Contents
Part I: Special Perioperative Considerations in the Elderly
Chapter 1: Bone Health, Advances in Assessment and Treatment
Introduction
Identification of Patients at Risk for Postoperative Complications
Dual-Energy X-ray Absorptiometry (DXA)
Computed Tomography (CT)-Based Techniques
Trabecular Bone Score (TBS)
High-Resolution Peripheral QCT (HR-pQCT)
Optimization of Bone Strength Perioperatively
Bisphosphonates
Anabolic Agents: Teriparatide
Anabolic Agents: Abaloparatide
Combination Therapy
Conclusion
References
Chapter 2: Antithrombotic Management in Spine Surgery in the Elderly
Introduction
Preoperative Antithrombotic Therapy
Antithrombotic Agent Classes
Antiplatelets
Aspirin (Acetylsalicylic Acid, ASA)
Clopidogrel and Other P2Y12 Receptor Antagonists
Oral Anticoagulants
Warfarin
Direct Oral Anticoagulants (DOACs)
Heparin Compounds
Unfractionated Heparin (UFH)
Low Molecular Weight Heparin (LMWH)
Fondaparinux
Bridging Anticoagulation
Intraoperative Anticoagulation
Postoperative Antithrombotic Therapy
Antiplatelets
Aspirin (Acetylsalicylic Acid, ASA)
Clopidogrel and Other P2Y12 Receptor Antagonists
Oral Anticoagulants
Warfarin
Direct Oral Anticoagulants (DOACs)
Heparin Compounds
Unfractionated Heparin and LMWH
Antithrombotic Management in the Emergent Setting
Antiplatelets
Aspirin
Clopidogrel
Oral Anticoagulants
Warfarin
DOACs
Heparin Compounds
Unfractionated Heparin
LMWH
Fondaparinux
Special Considerations
Changes in Body Composition
Pharmacokinetics
Absorption
Volume of Distribution
Protein Binding
Clearance. Hepatic Impairment
Renal Impairment
Fall Risk
Diet
Polypharmacy
Future Directions
References
Chapter 3: Managing Multiple Medical Comorbidities
Pre-operative Risk Stratification and Communication of Risk
Geriatric-Specific Risk Factors
Age as a Risk Factor
Obesity
Management of Diabetes
Cardiac and Pulmonary Disease
Venous Thromboembolism
Anemia
Delirium
Pain Management Before and After Surgery
Smoking, Alcohol, and Substance Use
Post-operative Disposition
Conclusions
Bibliography
Chapter 4: Anesthetic Concerns for Spinal Surgery in the Elderly
Introduction
Age-Related Physiologic Changes
Central Nervous System
Cardiovascular
Respiratory
Renal
Gastrointestinal
Musculoskeletal and Cutaneous
Preanesthetic Consultation
Frailty
Prehabilitation
Cognition and Dementia
Medication Management
Intraoperative Management
Anesthetic Techniques: General and Regional Anesthesia and Monitored Anesthesia Care
Depth of Sedation
Hemodynamic Perfusion Monitoring
Intraoperative Neurophysiological Monitoring
Postoperative Management
Screening for Delirium
Postoperative Cognitive Dysfunction
Management Strategies
Conclusions
References
Chapter 5: Spinal Prehab/Rehab in the Elderly
Early Postoperative Rehabilitation
Conclusion
References
Chapter 6: ERAS and Spine Surgery
Introduction
Rationale for the Use of ERAS in Spinal Surgery
ERAS Components
Preoperative Period
Intraoperative Period
Postoperative Period
Outcomes by Type of Spine Surgery
Surgery by Anatomical Level
Minimally Invasive Surgery
Deformity Surgery
Tumor Surgery
Outcomes in Elderly Patients
ERAS Implementation
Conclusion
References
Part II: Spine Disease in the Elderly. Chapter 7: Surgical Treatment of Cervical Spondylotic Myelopathy
Introduction
Pathophysiology
Elderly Perioperative Considerations
Surgical Management
Ventral Approaches
ACDF
Corpectomy
Dorsal Approaches
Laminectomy
Laminectomy and Fusion
Laminoplasty
Combined Approach
Complications
Age
Approach
Common Complications
Future Research
Conclusions
References
Chapter 8: Atlantoaxial Fracture Management
Introduction
Anatomy and Mechanical Properties of the Atlantoaxial Complex
Epidemiology
Odontoid Fractures
Diagnosis
Imaging
Morbidity and Mortality
Management
External Immobilization
Operative Management
Fractures of the Atlas
Diagnosis and Treatment
C1-2 Dislocation and Subluxation
Imaging and Diagnosis
Treatment
Hangman's Fractures
The Modified Effendi Classification System
Diagnosis
Management and Operative Technique
Conclusions
References
Chapter 9: MIS Cervical Approaches in the Elderly
Introduction
MIS Posterior Fusion via Facet Joint Arthrodesis
MIS Posterior Cervical Foraminotomy (PCF)
Tubular Cervical Unilateral Laminotomy for Bilateral Decompression
Conclusion
References
Chapter 10: Subaxial Spinal Trauma
Introduction
Epidemiology
Etiology
Diagnosis
Classification
Treatment
Outcomes, Mortality and Complications
References
Chapter 11: Anterior vs. Posterior Cervical Approaches for the Elderly
Introduction
Patient Selection
Cervical Spine Alignment
Number of Levels Requiring Decompression
Approach-Related Complications to Consider
C5, C8, and T1 Nerve Root Injuries
Dysphagia
Dysphonia
Wound Complications
Other Considerations
OPLL
Pseudarthrosis
Revision Surgery
Anterior Cervical Approaches. Anterior Cervical Discectomy and Fusion (ACDF)
Other Surgical Considerations
Anterior Cervical Corpectomy and Fusion (ACCF)
Other Surgical Considerations
Anterior Cervical Hemi-Corpectomy and Fusion (ACHCF)
Cervical Disc Arthroplasty (CDA)
Posterior Cervical Approaches
Laminectomy and Fusion
Laminoplasty
Laminoplasty Versus ACDF
Laminoplasty Versus Laminectomy and Fusion
Conclusion
References
Chapter 12: Cervical Spine Disease in Elderly Patients with Ankylosing Spondylitis
Background and Etiology
Epidemiology and Risk Factors
Medical Treatments for AS
Cervical Spine Fracture in the Elderly
Cervical Deformity in the Elderly
Navigation Technology for the Surgical Treatment of Ankylosing Spondylitis
Nanomedicine: A Novel Treatment
AI and Technological Modeling
References
Chapter 13: Cervical Spine Deformity in the Elderly
Background
Cervical Spinal Deformity Development in the Elderly
Evaluation for Surgery in Cervical Spine Deformity in the Elderly
Initial Evaluation
Radiographic Evaluation
Surgical Planning
Algorithmic Approach to Cervical Spine Deformity Correction
Fixed Deformity Without Ankylosis
Fixed Deformity with Anterior Ankylosis
Fixed Deformity with Posterior Ankylosis
Fixed Deformity with Circumferentially Fused Cervicothoracic Junction
Flexible Deformity with Mild Kyphosis
Flexible Deformity with Moderate Kyphosis
Flexible Deformity with Severe Kyphosis
Radiographic Success After Cervical Spine Deformity Correction in the Elderly
Complications After Cervical Spine Deformity Correction in the Elderly
Conclusion
References
Chapter 14: Spinal Cord Injury in the Elderly Population
Introduction
Central Cord Syndrome. Spinal Trauma Associated with SCI: Odontoid Fracture, Penetrating Injury, and Fracture Dislocation
Odontoid Fractures
Penetrating Injury
Thoracolumbar Fracture/Dislocation Associated with SCI
Medical Management
Surgical Management
Outcomes
Experimental Treatments
Conclusion
References
Chapter 15: Cervical Spinal Oncology
Introduction
Frailty in the Elderly Spine Oncology Patient
Primary Spine Tumors
Tumors of the Vertebral Column
Tumors of the Spinal Cord and Meninges
Intradural Extramedullary Lesions
Intradural Intramedullary (Intrinsic) Lesions
Metastatic Lesions
Goals of Surgery
Who Is a Surgical Candidate?
Minimally Invasive Surgical Techniques and Alternatives for Frail Patients
Nonsurgical Alternatives
Conclusion
References
Part III: Thoracolumbar Disease in the Elderly
Chapter 16: Management of Spondylolisthesis in the Elderly Population
Introduction
Diagnosis
Nonsurgical Treatment
Physical Therapy
Medications and Injections
Conservative vs. Surgical Treatment
Surgical Treatment
Indications for Surgical Treatment
Overview of Surgical Alternatives for Lumbar Spondylolisthesis
Outcomes of Surgical Treatment
Complications
Conclusion
References
Chapter 17: Sagittal Plane Deformity Considerations in the Elderly
Pathophysiology
Radiographic Parameters
Pelvic Parameters
Pelvic Incidence
Pelvic Tilt
Sacral Slope
Regional Spine Alignment
Relationship of Lumbar Lordosis to Pelvic Incidence
Roussouly Spine Types
Global Spinal Alignment
Radiographic Parameters and Patient-Reported Outcomes
Age-Adjusted Radiographic Parameters
Surgical Correction of Adult Spinal Deformity in the Elderly
Conclusion
References
Chapter 18: Revision Surgery in the Elderly
Introduction.