“Imagine struggling to get up from your bed to go to the bathroom, or to sit down at the dining table for your next meal. Imagine finding such simple tasks as eating with a spoon or putting on your clothes becoming next to impossible,” says Dr Sajan Hegde, Chief Spinal Surgeon at Apollo Hospitals, Chennai.
In his daily practice, says Dr Sajan, he is seeing a growing number of older patients come in with debilitating back pain or weakness. Even as people are living longer thanks to medical advances, a significant number of older persons face drastic reductions to their quality of life due to age-related spinal disorders.
Spinal problems are particularly debilitating, he adds, because they affect virtually every activity in daily life, and make everything from sitting to walking painful. “And these days, many of their children move abroad or elsewhere in the country. They may come back and take care of their parents when they are very sick. But eventually, they have their own lives to return to. So, it’s very important that older people remain reasonably functional and fit so that they can take care of themselves,” the spine specialist adds.
How spine problems affect the elderly
The spine is a complex structure composed of 24 stacked up in a column stretching from the base of the skull to the tailbone. These bones are linked together by joints called spinal facets, with discs of jelly-like substance forming cushioning layers between them. As people age, this complex structure undergoes wear and tear, resulting in a few common conditions:
- Degenerative discs: Here, the cushioning discs get worn down, and become unable to prevent the vertebrae from rubbing against each other, which leads to osteoarthritis. This results in back stiffness and pain.
- Stenosis: Stenosis occurs when the spaces through which the spinal nerves travel become narrowed. These nerves then become pinched, causing pain, numbness or weakness in the legs. This is the most common cause of back pain in older patients.
- Osteoporosis: Particularly in women, aging can result in the loss of bone density, which weakens the vertebrae and increases the likelihood of fractures.
“People should be aware about whether they are able to do their day-to-day activities without too much discomfort,” says Dr Sajan. If one experiences prolonged pain in the back or legs, especially radiating pain, or if one feels weakness in the arms and legs and excessive stiffness while doing everyday tasks, it’s useful to consult a spine specialist, he adds.
Major advances in surgery
While pain and discomfort can be managed to a certain extent through medication, exercise and implements like braces, says Dr Sajan, if the condition becomes severe surgery is vital. However, while most of his patients have approached him early and without delay, Dr Sajan says that there is a still a lot of fear about spinal surgery.
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Dr. Sajan Hegde, Chief Spine Surgeon, Apollo Hospitals.
“When you talk to a lot of people, you hear stories from them saying, ‘My uncle got paralysed and never walked again after surgery.’ It was not unfounded 20 or 30 years ago that surgery could leave the patient with more problems than what they began with. That was because earlier the medical technology just wasn’t there,” says Dr Sajan.
In the last few decades, he explains, massive advances have taken place in medical technology and doctor expertise that has significantly reduced such risks. “When you come to a place like Apollo, for instance, we have such expert anaesthetists that going under anaesthesia is safe even for people over the age of 85 years. We’ve had 85- and 90-year-olds come in on wheelchairs and we’ve removed their compressions and helped them walk.”
Another major advance he points to is the development of sophisticated imaging technologies such as next-generation MRIs and high-resolution CT scans, which allow surgeons to know with great precision just where to make their interventions. “Earlier, there was a lot of guesswork. There would even be cases where surgeons would have to open up a patient and then figure out what to do,” he says.
In the surgical suite too, the level of precision has increased manifold, says Dr Sajan. In cases where high-precision work is needed to fix implants that help realign the spine, there are now robotic technologies available that are far more precise than human hands. Moreover, while surgical burs are conventionally used to painstakingly grind or cut through bone, cutting-edge technology in the form of ultrasonic scalpels is now available in leading spinal units such as at Apollo Hospitals. “These use ultrasonic waves to cut through bone. This greatly reduces the open bleeding areas and drastically reduces the chances of damaging the spinal cord. It is very precise and operations that earlier took three-four hours can now be completed within 10-15 minutes,” he explains.
This article was produced by TNM Brand Studio in association with Apollo Hospitals.