Treatment for Spinal Stenosis in Elderly

Spinal stenosis is one of the most common spinal conditions in the elderly. Unfortunately, despite its prevalence, many older individuals struggle to receive effective treatment for their symptoms. Non-surgical treatments are safer for elderly patients, but may not completely resolve spinal stenosis symptoms. 

What Is the First-Line Treatment for Spinal Stenosis in People Aged 75+?

The first-line treatment for spinal stenosis in people aged 75+ includes physical therapy, anti-inflammatory medications, and epidural steroid injections. 

Non-surgical treatments are almost always recommended first for spinal stenosis. Surgery poses the risk of complications and involves a significant recovery period, so it’s generally avoided unless conservative treatments fail to provide relief. 

  • Physical therapy is one of the most effective non-invasive treatments for spinal stenosis. It can reduce spinal symptoms by improving mobility, posture, circulation, and muscle strength. PT exercises and treatments can also help reduce muscle tension in the back, which may improve spinal stenosis symptoms.
    • One study found that after two years, patients who underwent physical therapy for lumbar spinal stenosis had comparable pain levels and physical function to those who underwent surgery. These results are particularly compelling for elderly patients, who are more vulnerable to surgical complications. 
  • Anti-inflammatory medications, like NSAIDs, are a non-surgical treatment option for spinal stenosis. They work by blocking prostaglandins, hormone-like substances that contribute to inflammation. This leads to a reduction in inflammation and pain.
    • It’s important to note that anti-inflammatory medications come with various risks (such as increased bleeding and gastrointestinal ulceration), especially in older adults. In general, anti-inflammatory drugs aren’t considered a long-term solution for spinal problems. 
  • Epidural steroid injections involve injecting corticosteroid medication into the epidural space of the spinal canal. This provides relief from pain, swelling, and other spinal stenosis symptoms. However, epidural steroid injections must be used in moderation, especially in older adults, because they can lead to tissue atrophy.
    • A two-year study published in the European Journal of Pain found that epidural steroids show little promise for providing long-term benefits in older adults with new back and leg pain episodes. However, further research into the effectiveness of epidural steroid injections for spinal stenosis in elderly patients is needed to confirm these results.
  • Alternative therapies like heat, acupuncture, massage, and meditation are compelling options for older patients, as they’re non-invasive, drug-free, and pose a far lower risk of complications than many conventional treatments. They can also be safely combined with most other spinal stenosis treatments, helping to enhance their benefits, lower pain levels, and improve mobility. Just make sure to visit a licensed, qualified alternative therapy provider, as there are fewer restrictions surrounding these treatments. 

Long-Term Spinal Stenosis Management for the Elderly 

For the elderly, long-term spinal stenosis management centers around pain management, preserving mobility, and improving quality of life. This may involve:

  • Lifestyle modifications like staying active, eating healthily, and maintaining good posture
  • Home remedies like heat and cold therapy and gentle stretches to minimize pain
  • Pain medications, as prescribed, to prevent discomfort with daily activities
  • Ongoing physical therapy sessions 
  • Periodic doctor appointments to make adjustments to your treatment plan (as needed)

Spinal Stenosis Prevention for Older Adults

Preventing spinal stenosis can help older adults avoid invasive treatments. While spinal degeneration can’t be entirely prevented, consider these tips to protect your spinal health with age:

  • Reach and maintain a healthy weight to limit excessive stress on the spine. If you’re struggling to shed extra pounds, talk to your doctor for support. They may recommend personalized dietary changes, working with a trainer, and addressing underlying factors that could be contributing to your weight (i.e. a hormonal imbalance).
  • Quit smoking, as it’s directly linked to accelerated spinal degeneration.
  • Consider adopting an anti-inflammatory diet to tackle ongoing inflammation, which contributes to back pain and spinal conditions. Anti-inflammatory diets prioritize unprocessed foods rich in omega-3 fatty acids, fiber, polyphenols, and vitamin C.

Should a 75-Year-Old Have Spinal Stenosis Surgery?

A 75-year-old should have spinal stenosis surgery if it’s determined to be the best treatment option by a spinal specialist. 

Although the risks of spinal stenosis are higher among people aged 70 and older, it’s still a feasible treatment option in some cases. However, doctors, patients, and loved ones need to consider the elevated risk of complications.

Multiple studies have revealed spinal fusion complication rates from 5.1% to 13% in elderly patients. Most spinal surgery complications involve one of the following medical concerns:

  • Blood loss
  • Wound healing
  • Hardware issues
  • Cerebrospinal fluid leakage
  • Pulmonary embolism
  • Thrombophlebitis (vein inflammation, often from a blood clot)

Recovery timelines can also influence whether or not a 75-year-old should have spinal stenosis surgery. After invasive procedures like spinal fusion, for example, older patients may need to stay in a rehabilitation facility for days or even weeks before returning home. Minimally-invasive spine surgery can shorten recovery times for elderly patients, but still require a few weeks or months of rest and rehabilitation. 

The risks of spinal stenosis may outweigh the benefits for some older adults. In these cases, the physician will recommend non-surgical treatments to preserve your quality of life and prevent severe complications. 

What Do Seniors Risk With Spine Surgery?

With spine surgery, seniors risk blood clots, blood loss, infections, post-operative falls, and failed spinal surgery. 

  • Blood clots are a serious risk in all surgical procedures, but the risk is higher in seniors. Age and low mobility are risk factors for blood clots, making them a major consideration for older adults before spine surgery. 
  • Blood loss results from cutting tissue to access the spine. In younger individuals, the body can usually recover quickly and effectively from blood loss in spinal surgery. But, in older adults, the body can’t bounce back as well, creating the risk of complications from blood loss. 
  • Infections after spinal surgery can occur if bacteria enter the surgical site. Older age is a known risk factor for infections after surgery, as the body becomes less able to fight off infection over time. 
  • Post-operative falls are a significant risk for seniors after spine surgery. The risk of falls is already heightened for the older populations, and this risk increases after surgical procedures. Falls can lead to debilitating fractures, head injuries, and reduced mobility.  
  • Failed spinal surgery is a notable risk that’s more prevalent in seniors. Success rates for spine surgery decrease with age, as the body healing process becomes less effective. Additionally, seniors have higher rates of spinal degeneration than younger patients, which increases the probability that a spine surgery will fail.  

How to Minimize Risks of Spinal Stenosis Surgery for the Elderly

You can minimize the risks of spinal stenosis surgery for the elderly by evaluating risk factors, preparing for the procedure, and opting for a minimally invasive procedure.  

Evaluating Risk Factors

Thoroughly evaluating the patient’s risk factors before considering spinal stenosis surgery is essential to minimize risks in the elderly population. A spinal specialist can determine if the risks are too high to undergo the procedure safely. 

Serious risk factors for complications after spinal stenosis surgery include:

  • Multiple comorbidities (having multiple chronic conditions)
  • Complex prescription medication regimens
  • Functional limitations (difficulty with mobility, vision, hearing, communication, or cognition)
  • Frailty
  • Cognitive impairment 

Elderly patients with the risk factors listed above are often advised not to undergo spine surgery.  and adjacent segment degeneration. 

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Preparing for Spinal Stenosis Surgery

Thoroughly preparing for spinal stenosis surgery and following all of your physician’s pre-op instructions can help minimize risks for elderly patients. This may include improving your overall health as much as possible by:

  • Eating a nutrient-dense diet with plenty of lean protein and unprocessed carbohydrates
  • Managing blood sugar levels, for diabetic patients
  • Quitting smoking
  • Optimizing iron levels, for frail patients

Preparing for spinal stenosis surgery should also involve arranging transportation home from the hospital and for someone to stay with you after the procedure. This is important, as you may be unable to perform tasks around the house in the first few days or weeks. 

You can also prepare your home before the operation by:

  • Raising your bed so it’s easier to get into
  • Removing cords, rugs, and any other items that could cause tripping from the walkways
  • Preparing laundry
  • Stocking nutritious pre-made meals and snacks

Post-Surgery Lifestyle Modifications

Even minor lifestyle modifications can help elderly patients recover faster from spinal surgery. Some of the most common doctor-recommended adjustments are:

  • Exercise: Gentle, low-impact exercise has been linked to better spine surgery outcomes. While this can be challenging for older adults with limited mobility, swimming, water aerobics, and working with a rehabilitation specialist are all excellent options. 
  • Diet: Reduced appetite, underlying medical conditions, and a reduced ability to chew and swallow can make it more difficult for the elderly to eat a balanced diet. But nutrition is more crucial than ever after surgery, as nutrients like protein, calcium, vitamin D, vitamin C, vitamin K, and zinc all play important roles in tissue healing. Meal prep and support from loved ones can ensure older patients eat healthily after spine surgery for the best possible healing process. 
  • Avoiding Bed Rest: Fatigue is particularly common among older adults, often making it difficult to get out of bed and stay mobile. But excessive bed rest after spine surgery can contribute to pain, stiffness, and even muscle atrophy, compromising the benefits of the procedure. So, aim to limit sedentary time while following your surgeon’s post-op guidance. 
  • Quit Smoking: Although smoking isn’t as common among older adults as younger adults, older smokers are half as likely to kick the habit. Smoking is detrimental to your post-surgery recovery, as it reduces blood flow throughout the body while increasing the risk of heart-related complications. Ideally, patients should commit to quitting smoking long before the procedure, as it will protect their overall health while promoting better surgical outcomes. 

Minimally-Invasive Surgery

Modern, minimally-invasive spinal procedures like the TOPS System can reduce the risks of spinal stenosis surgery for the elderly. As an alternative to fusion for lumbar spinal stenosis, the TOPS System is a spinal implant that reduces the risk of failed fusion and adjacent segment degeneration. 

TOPS is implanted during a minimally invasive procedure, which lowers the risk of bleeding and other postoperative complications. The implant restores a controlled range of motion in the spine, preventing lost mobility after spinal stenosis. After the TOPS procedure, patients can safely move the spine in all directions. 

Along with a lower risk of surgical complications, the TOPS System can shorten recovery timelines for elderly spinal stenosis patients. Remarkably, many patients can move around the day after the TOPS procedure. While older patients may need more time to get back on their feet, the TOPS device is designed to preserve mobility and doesn’t require a lengthy bone healing process (like fusion does). 

To learn more about whether you’re a candidate for spinal stenosis surgery, reach out to a specialist in your area.