2 Spineage-related changes inAging spineAge-Related Changes in the Spine

Vertebral bodiesage-related changes inThoracic hyperkyphosisSpinal ligamentsage-related changes inRange of motion, loss ofLigamentum flavum, hypertrophy ofKyphosisthoracic hyperkyphosisIntervertebral discsage-related changes inHyperkyphosisHyperkyphosisFlexibility, loss ofDegenerative processBalance, spinalage-related changes inAging spinedynamic adaptation toAging spinedegenerative process inThe progressive degenerative changes associated with aging gradually affect all components of the spine and associated structures. The degenerative process begins early, during the first decade of life in the intervertebral disc. This process involves biochemical changes that are followed by macroscopic alterations, including tears and fissures. Ultimately, this may lead to loss of disc height and disc herniation. Facet joint hypertrophy and laxity often follow. Other accompanying changes include osteoporosis of the vertebral bodies, hypertrophy of the ligamentum flavum, and weakening of the paraspinal musculature. The accumulation of these age-related modifications causes narrowing of the spinal canal and collapse of the vertebral body to varying degrees. In addition, the dynamic adaptation of the spine to the forces involved in daily activities also contributes to the alterations. The excessive compensation can sometimes lead to pathological conditions, such as thoracic hyperkyphosis, which contributes to global sagittal imbalance and deformity. Furthermore, the flexibility and range of motion in both cervical and lumbar spines diminish with age. Degenerative changes in the spine are features of the normal aging process. This chapter provides the reader with an understanding of these age-related changes to provide an understanding of the natural history of spine degeneration in order to guide diagnosis of pathological conditions and determine treatment strategies.