The Geriatric Spine Syndrome: Pathophysiology

By | June 18, 2011

Notice the tortuous nature of this severely scoliotic spine.

An interesting fact about the two forms of the Geriatric Spine Syndrome is that although they have different anatomical features and pathophysiological mechanisms they share a remarkably similar set of symptoms. The pain begins as a dull ache primarily in the back and after a period of years tends to become sharper and spread, fist into the buttocks and then into one or both of the legs.

 

In the osteoporotic form of the syndrome the pain early on seems to come from the compression fractures and their affect on the overall alignment. As the degenerative scoliosis worsens pain generators in the facet joints are activated. This caused progressive worsening of the axial back pain. Finally as the scoliosis becomes more and more severe the patient may develop bowstringing of the cauda equina or severe foramenal stenosis at one or more levels. At this point the pain may suddenly change in character and location the addition of a sharp, electrical or burning component, which may be localized or spread widely over the legs. If the foramenal stenosis becomes severe enough the patient may develop a foot drop or other motor symptoms, but a full-blown cauda equina syndrome is unusual.

 

The arthritic and hypertrophic form of the syndrome also usually begins with dull aching pain in the back although radiation to the buttocks will be reported even at the earliest stages if the patient is specifically asked. As the hypertrophic changes in the spine progress central canal stenosis will cause the pain to become sharper and sharper and radiate more clearly into the legs. The spinal stenosis can progress to the point of near obliteration of the central canal resulting in a cauda equina syndrome with motor weakness as well as bowel and bladder symptoms. Isolated radiculopathies resulting from disc disease or critical foramenal stenosis are rare.

 


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