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Saturday, October 23, 2021

Surgery for Degenerative Spondylolisthesis for People Aged 60+

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Spondylolisthesis surgery is quite a debated topic amongst surgeons. Most of them agree that decompressing the nerves is a great way to provide relief to the patient. But some surgeons have argued against the system that is used in spondylolisthesis surgery, as they believe that the vertebra does not need to be realigned in most cases. Generally, spondylolisthesis refers to the disease that is caused by the slipping of one vertebra down onto the lower consecutive vertebra. 

In most cases, this leads to nerves being under pressure, which causes lower back pain and leg pain. Spondylolisthesis is mostly seen in about 4-6% of the adult population throughout the world. While there are several different types of this disease, the one we will focus on is “Degenerative Spondylolisthesis”, which affects people in the age group of 50-60 or above. 

In this article, we will briefly talk about the dynamics of this disease, the system that is used in spondylolisthesis surgery, and how safe or unsafe it is for people over the age of 60. 

Why Does Degenerative Spondylolisthesis Occur in People Aged 60+? 

To understand the answer to this question, we will first have to take a look at the structure of the spine and the intricate joints between the vertebrae. 

The spine consists of a long line of joints and discs arranged in a manner that allows the vertebrae to slide over each other and be flexible. The discs are located in the front, with the joints on the backside. 

The joints serve the purpose of limiting the movement of the spine, and the discs absorb shock from impacts. The forward movement of the spine is referred to as “Flexion” and the backward movement as “Extension”. 

In people above the age of 50, the facet joints become slack and allow for too much flexion, which leads to the vertebrae slipping over one another. Now that you have a clear idea about degenerative spondylolisthesis, we can take a look at the various surgical procedures used to correct it. 

Surgery for Degenerative Spondylolisthesis 

Correctional surgery for degenerative spondylolisthesis is not always required as most of the issues can be managed by tackling the symptoms individually. But, in some cases where either the pain levels are unmanageable or there is greater progressive neurological damage over time, surgery may be considered important. 

To put it in layman’s terms, the surgery is aimed at trying to realign the affected vertebrae and reduce pressure on the nerves being pushed by the segment. Surgery can be a nerve-racking process for anybody and hence, it is important to be informed about the crucial parts of the whole process. 

First, let’s take a look at the types of surgery that are used to correct degenerative spondylolisthesis.

Different Types of Spinal Fusion Surgery for Correction of Degenerative Spondylolisthesis 

Generally, the surgical system that is used in spondylolisthesis surgery includes ALIF (Anterior Lumbar Interbody Fusion), PLIF (Posterior Lumbar Interbody Fusion), and TLIF (Transforaminal Lumbar Interbody Fusion). 

These procedures differentiate between the approach that surgeons take depending upon the progression of the disease and a few other factors. 

  • ALIF 

In ALIF, the spine is accessed from the front of the body. Normally this is done through an incision on the left side of the abdomen. It can be either minimal or open, depending upon the patient’s overall condition. Mini ALIFs are more preferred as the surgeon can preserve the muscles in that part, and the incisions are much smaller, leading to faster recovery times. 

  • PLIF

PLIF is a more commonly used procedure for the treatment of degenerative spondylolisthesis. Similar to the aforementioned technique, PLIF can either be done in an open or minimal procedure. Here, the facet joints are trimmed to get access to the underlying nerve roots and discs. The size of the part being trimmed depends on the size of the implant being grafted and the affected segment of the spinal cord.

  • TLIF

With TLIF, the approach is to fuse both the anterior and the posterior sections of the spine. The process is quite similar to PLIF, but here the bone grafts and stabilization using an interbody device are done on the anterior, with the rods, screws, and other bone grafts being connected to the posterior. 

ALIF, PLIF, and TLIF all aim to solve the same problems, but with different approaches that best suit the patient. The main goals with these techniques are to decompress the nerve roots to reduce pressure, align the vertebrae, and stabilize the structure of the spine. 

After the surgery, the hospital stay time ranges from just a day to about 4 days. But the bone can take about a year to fully heal with regular activity aiding the process. Patients can resume normal activities after about three months.

Potential Benefits and Risks of Degenerative Spondylolisthesis Correction Surgery

Benefits 

The modern system that is used in spondylolisthesis surgery ensures that the recovery period is minimal, and the surgery doesn’t stress out the patient’s body too much. Overall, this surgery has a very high success rate, and the patients often return to their normal lives with a bit of rehabilitation to get back to near-prime function. 

Risks

The decompression surgery (laminectomy) done during the surgery process can lead to nerve root damage in very rare cases. Also, the fusion process can fail and lead to arthrodesis (nonfusion) between the vertebrae being attached. But, your surgeon will often gauge if there are any chances of complications happening at a later point, and advise you accordingly. 

Final Words

Facing degenerative spondylolisthesis is a common occurrence in people aged over 60. However, there are only a few cases of this disease that are serious enough to warrant surgery. Most of the potential problems that come with the system that is used in spondylolisthesis surgery can be avoided by trying the non-surgical options available. 

But, the breakthroughs of modern surgical techniques ensure that in case you do need the surgery, the recovery rates are very high, and many people have regained their active lives because of it. 

 

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