Spinal aging

The age distribution of the global population is shifting upwards. As a result, clinicians worldwide are faced with an increasing number of spinal disorders related to the elderly and spinal aging. Spinal pathology in the elderly specifically includes osteoporosis and osteoporotic vertebral compression fractures and degenerative spinal deformity. The impact of spinal disorders on health-related quality of life is more severe than the impact of many common diseases, such as cardiovascular diseases or type 2 diabetes. Spinal disorders affect more than 1.7 billion people worldwide and represent significant economic costs to society by the utilization of vast amounts of healthcare resources and by indirect costs such as loss of productivity. With the aging of our population the burden of spinal disorders on society is estimated to increase even further. Spinal aging encompasses a set of spinal disorders which are complex and heterogeneous with highly individualized surgical planning. As this patient category is associated with multiple medical comorbidities, decreased mobility, poor balance, and a greater propensity to falling, more patient tailored and multidisciplinary treatment strategies will be needed. Due to the confluence of an aging population and an increased capacity and willingness by the spinal community to manage difficult problems in older patients, it is essential that, when designing and implementing therapeutic strategies, clinicians must consider all of these factors. By shared decision making, medical and technical knowledge from surgeons is combined with values and preferences from patients in order to achieve effective and safe treatment modalities and ensure adequate patient support. This thesis addresses both clinical and preclinical aspects of spinal aging. In anticipation of an aging population, the main motivation of this thesis was to emphasize the significant and growing burden of spinal disorders in the elderly; to optimize current conservative and operative treatment for spinal aging; and to argue that allocation of resources to the management of spinal disorders should be a priority for our healthcare economy