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. 

This article will explore the available treatment options for spinal stenosis in older individuals. 

Table of Contents

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. 
  • Anti-inflammatory medications are a non-surgical treatment option for spinal stenosis. They work by blocking prostaglandins, which are 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. 

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. 

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. 

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 that’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

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. 

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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. 

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