Spinal health and ageing: Tips for a healthy back in later life

The spine consists of bones called vertebrae and discs between two bones. The disc is an avascular structure – meaning it has no blood supply of its own; instead, it gets its nutrition from the surrounding bones. Since the disc is a soft structure and takes on a lot of load, it ends up getting degenerated because over time due to aging and the constant pressure it bears. These discs wear out faster than the bones and joints of the spine, leading to degeneration of discs.

Herniated Disc and Nerve Compression

One of the main issues with disc degeneration is herniation. On MRI scans, a degenerated disc may appear dark in color and bulge out. The bulging of the disc can compress spinal nerves – crucial structures from the brain that run down the spine within the spinal canal. This compression can result in back pain and, in some cases, pain radiating down the legs—a condition medically termed Sciatica . When this occurs in both legs, it can be quite serious. Increased compression can also result in catastrophic consequences like loss of bowel and bladder control. This condition is known as lumbar canal stenosis , which requires a surgical solution.

While disc degeneration is unavoidable, there are ways to treat acute symptoms and strengthen the spine with exercise and by maintaining proper posture. This can protect the spine against microtrauma—small injuries that can lead to neurological deficits and weakness in the limbs.

Facet Joint Wear and Spinal Alignment Issues

Between the vertebrae, there are also two joints called facet joints , located at the posterior part of the spine. These joints, like the knee joints, can wear out over time, much like what occurs in osteoarthritis. However, unlike the knee, where joint replacement is possible, there is no device available to replace worn-out spinal joints. When the spinal joints deteriorate, they can weaken the stability of the spine and cause a misalignment. The facet joints keep the spine in a straight line, and with wear and tear, there can be forward slippage of the spine—a condition known as spondylolisthesis , which can again contribute to spinal canal stenosis. While spondylolisthesis due to aging is unavoidable, exercise can help by strengthening the muscles around the spine, preventing further slippage, and maintaining proper alignment.



Osteoporosis and Bone Health in Aging

The third major component of spinal aging pertains to bone health. As we age, bone quality (bone density and bone strength) diminishes, becoming brittle and hollow—a condition known as osteoporosis. This is eight times more common in women than in men. People with osteoporosis are more susceptible to fractures, even from simple actions like sneezing or a trivial fall. Osteoporotic fractures of the spine are fast becoming increasingly common among the elderly worldwide.

Tips for a Healthy Back in Later Life

We urge people to engage in regular weight-bearing exercise from a very young age. Weightlifting with sporting activities stimulates bone formation which would work as a bone bank for entire life, helping to reduce the risk of fractures in old age. Apart from this, the elderly should consider regular bone density testing every 2 years – for women, after reaching menopause, and in men, over the age of 60.

Awareness about osteoporosis is important as it’s a largely preventable condition. Early detection of osteoporosis allows for timely treatment, which can help reduce the risk of fractures. While treatment may not fully restore bone quality to that of a younger person, it significantly reduces the risk of fractures.

To sum up, the ageing spine can lead to issues like back pain, leg pain, disc herniation, lumbar canal stenosis, and fractures of the spine due to osteoporosis. Fortunately, all these conditions can be managed through various treatments, early detection, and preventative measures like exercise.

(Dr. Amrithlal. A. Mascarenhas, Consultant - Spine Surgery, Manipal Hospital Millers Road.)