There are times when you must make firm decisions. Looking after an elderly person with severe arthritis causing pain requires a hard decision. Leave them in pain, waiting for death or allow them to have surgery. That came recently when we had to operate on a lady disabled by pain. A diabetic, hypertensive lady who cannot stand, walk or lie down comfortably. Her MRI scan showed severe pressure on her spinal cord – by arthritis. She needs an operation. She is 70 years old. c
The major concern for patients and relatives is the age of the patient. Some consider anyone above 55 as too old for spine surgery and similarly, anyone below 30, as too young. A misconception, of course. Age has little to do with spine surgery. We can operate on any deserving person so long as there is a good reason for surgery and they are medically fit to undergo the operation.
They have to be assessed and certified fit for the operation and the type of anesthesia that may be required. We also try to ensure that the real benefits of the operation outweigh the possible side effects inherent in the operation. Finally, we have to be sure we can provide a safe environment for the patient to have a successful procedure.
Arthritis in the elderly
The causes of back pain are nearly as numerous as terms used to describe the symptoms. Back pain can be caused by arthritis which is really wear and tear of the joints in the back. The joints simply wear out. More and more elderly will suffer from back pains, neck pain due to the degeneration caused by arthritis. Arthritis is one of God’s Apps: a computer program embedded in our genes!
Arthritis causes wearing out of the bones and pressure on the nerves and spinal cord. This destruction of the bone causes instability which may require operation to reinforce the bones. The pressure on the nerves may require operation to free the nerves and release the pressure.
Other causes of back pain are injury from poor positioning of the neck to falls and road traffic accidents. Another important cause is infection especially due to tuberculosis. Finally, we have some patients who have back pain from cancer in the bones.
Fear of spine surgery
There is real fear of spine surgery, especially in the elderly. The poor results of the past are still clouding the present and jeopardizing the future. The fear is of paralysis and death as well as of becoming disabled due to weakness of an arm or leg.
Because of this, many patients are not offered surgery and instead are taken to the village or to church. Many are left at home in pain until death eventually comes. Before death though, someone has to look after mama or papa, and someone may have to leave employment to stay home with them.
Elderly patients suffering from arthritis of the spine should not be left in pains and misery. More importantly, what is happening in the present? How many days will mama or papa suffer in pain, helpless and hopeless? How much pain can they tolerate? How can you cope with the misery and the cries in the middle of the night? Something should be done when an older person starts crying in the mornings and praying for early death on dark nights.
The important issue as regards planning for surgery is a firm diagnosis, clear evaluation of the physical status of the patient, assessment of the fitness for surgery, a clear surgical plan, honest balance of the benefits and risks of surgery in the hands of the surgeon and effective post- operative support by spine-trained physiotherapists.
Surgery on the spine is safe if performed by experienced surgeons and with adequate expert support from the nurses and physiotherapists.
Spine fixed in Nigeria
Age is no barrier to surgery in the elderly. If it can be done safely and if the benefits outweigh the risks, then, no problem! Of course, no one can guarantee 100 per cent success but the majority will benefit and have a new future.
Some doctors still believe that spine surgery is a death sentence. But, this is not true, at least not in Abuja. The operations have been performed safely on the neck and back for many patients with a good outcome in the majority.
We are collaborating and cooperating with many hospitals, many surgeons and industry to ensure we maintain and improve on the successes of managing the elderly.
Yes, you can trust your parents to us! Please don’t leave them in pain!