1 Department of Surgery (Neurosurgery) Dalhousie University. 2 Vice-Chair and Director of Research Professor, Division of Neurosurgery , Department of Surgery (Neurosurgery), Healthy Populations Institute Flagship Project Co-Lead, Creating Sustainable Health Systems in a Climate Crisis, Dalhousie University.
Abstract: The global population is ageing, and with that there is a concomitant increase in spinal pain and mobility complaints, most related to degenerative changes. It is important to consider how the markers of aging and, specifically, frailty, can overlap with symptoms of spine disease. Although non-operative management should be the initial response, spine surgery in older adults is safe and should be considered as part of a holistic approach for patients with persistent neuropathic pain.
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1. It is essential to remember that, while degeneration is inevitable, the appearance of symptoms is not and treatment decisions must be based on the clinical presentation, not the images.
2. Our ageing population will lead to an increase in the frequency of spine-related complaints.
3. It is important to consider how the markers of aging and frailty overlap with symptoms of spine disease.
4. The conservative approaches should always be pursued prior to consideration of surgical options.
5. When required, spine surgery in older patients is safe and efficacious, but should involve a healthcare team able to appropriately assess and support the patient and their loved ones.
1. Biological age does not necessarily equate to chronological age.
2. Radiological “abnormalities” become more common with age, but are frequently asymptomatic, order tests that direct care.
3. Combination, non-opioid, pharmacological strategies, with a ‘start low and go slow’ approach are preferred.
4. Tools such as the Clinical Frailty Scale can be helpful in predicting risk and clinical decision making.
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Abstract:Due to the distinctive anatomic and biomechanical features of the growing paediatric spine, children are susceptible to unique patterns of spinal injuries. Although clinical examination can help guide management, physicians are often required to rely on advanced imaging. Imaging interpretation can be challenging when considering that abnormal parameters among adults, are often within normal physiological limits in children. In general, spinal injuries in children younger than nine years of age are often managed non-operatively, while adolescents are typically managed by adult treatment principles. With the exception of neurologic injuries, most paediatric spinal injuries demonstrate good to excellent prognosis and outcomes.
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Due to the unique properties of the growing spine, including greater elasticity, osseous plasticity, presence of growth centers, relatively strong ligaments, and greater joint mobility, paediatric patients are susceptible to unique fracture patterns and injuries.
There are absolute contraindications regarding return to play decisions.
Children under 13 years of age with vertebral body compression fractures can progressively restore their vertebral height until skeletal maturity.
The vast majority of spine injuries among children under nine years of age, even when relatively unstable, can be managed non-operatively.
Pre-adolescent patients with complete spinal cord injuries are at high risk for developing progressive scoliosis and have not been shown to demonstrate any better neurological outcomes when compared to adults.
The cervical spine is the commonest area of spine injuries with the C1-3 vertebral levels being more commonly seen in children under eight years of age.
A standard immobilization board should not be used for children under eight years of age without an occipital recess or 2-3cm of padding to elevate their body relatively to their head.
Adult radiographic spinal parameters are often unreliable in children and severe neurologic injuries can be sustained in spite of normal imaging results.
Clinical examination is fairly unreliable for identifying spinal column injuries among pre-school patients and it is often necessary to rely on advanced imaging.
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Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.
Abstract: Athletes participating in training and competition for an average of 8 hours a week have a one year prevalence for spine injuries as high as 68%; an average increase of 18-31% compared to non-athletes. Except for young growing athletes at risk for structural deformity, most spine injuries are soft tissue and self-limiting. Risk factors include a sudden increase in training hours, transition in strength and coordination related to growth, sustained back flexion, reduced dynamic core stability and repetitive trunk rotation and hyper extension. Decreased training levels following back injury lead to deconditioning and muscle imbalance increasing the risk of recurrence and prolonging recovery. Core stability testing can identify patients for targeted exercise.
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Frequent repetition and sustained postures in rotation, hyperextension and full flexion require advanced levels of strength and flexibility for the athlete to remain injury-free.
The two most common risk factors for low back pain in training athletes is overuse strain and excessive spinal movements.
Treatment consists of both reducing the demands on the paraspinal muscles and increasing the amount of core stability.
It is important to screen for generalized joint hypermobility syndrome (JHS) affecting all joints using the Beighton Score, as this condition may require investigation and can be an indication of other medical syndromes.
The most specific test with high inter-rater reliability to determine core stability is the single leg standing balance stork test. The patient stands on one leg and raises the other knee to 90 degrees then maintains balance for a minimum of 25 seconds.
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