The document discusses the effects of aging on the spine. It summarizes that aging leads to morphological changes in the bony structures, intervertebral discs, ligaments and muscles of the spine. Specifically, it notes that aging causes a loss of bone mineral density in the vertebral bodies and endplates, a decrease in proteoglycans and water content in discs leading to dehydration and stiffening, and a decrease in strength and elasticity of ligaments and muscles. It further explains how these biological changes alter the biomechanics of the spine, increasing stresses on facets and risk for conditions like spinal stenosis and compression fractures.

1. DR. BAHAA ALI KORNAH
PROF.. OF ORTHOPEDIC
AL-AZHAR UNIVERSITY
CAIRO – EGYPT
AGING
EFFECT ON
SPINE

2. CONTENTS
• Introduction
• Adult spine
• Aging effect on spine
• Common spinal conditions
• Changes in diagnostic imaging
• Risk factors
• Physiotherapy effect onAging
• Prevention
• Precautions

3. SPINE

4. Aging
effect on
Morphological change
Bony
Vertebral body
Facet joints
Soft tissues
IVD
1.Endplate
2.Muscle and ligament
1.Biomechanical
changes
1.Creep characteristics of IVD
2.Kinematics of Functional spinal unit FSU
3.Compressive strength of V. body
4.Stress and intradiscal pressure across
IVD
5.Load sharing

5. As for every human tissue, aging
of the structural components of
the spine may be related to a
 Predetermined genetic cell
viability and
 Exposure of the tissues to
heavy mechanical forces
throughout life.

6. Aging of the bone

7. VERTEBRAL BODY
Trabeculae Cortical

8. CORTICAL BONE
•Decreased Cortical Thickness
•Important as a protective layer with
• high resistance to bending and
torsion.

9. TRABECULAR BONE
Increase the risk of fracture due to off-axis impact
Loss of Bone Mineral Density
Thinning of Trabeculae
Increase intratrabecular spacing
Loss of connectivity between trabecula
Increase anisotropy
Increase axial load

10. Decreased structural strength due
to reduced apparent bone density
and changes in the architecture of
the trabecular bone.
• The increase in bone fragility
is due to replacement of
platelike close trabecular
structures with more open,
rodlike structures.
The more porous cancellous bone
appearance is the result of
reduced horizontal cross-linking
struts
Normal osteoporotic

11. Intervertebral disc
Decrease Proteoglycan
Loss of water
Replace by collagen
Dehydration and stiffening
of annulus

12. Disc Compression
Vertical Loading
– Nucleus gets compressed
and radiates outward.
– Nucleus pushes on anulus
from within.
– Anulus fibers are in tension.

13. Disc disloged gradually from
vertebral rim
Decrease in intradiscal pressure and
altered load transmission
Disc collapses and height decreases
Cracks in annulus

14. Aging of the disc

16. Interverterbral disc space – foramen
progressive stenosis

17. Lumbar Stenosis
-
Developmental

18. ENDPLATE
Loss of bone mineral density
Thinning of endplate
Ossification of endplate
Increase risk of endplate fracture
due to nutrition and hydration of
IVD.

19. FACET JOINT
Disk degeneration
Multiplies load on facet
Arthritis
Denudation and ulcerative lesions of
articular cartilage, inflammatory
hypertrophy of synovial membrane

20. FACET JOINT
Osteophyte formation
Sclerosis of subchondral bone
Degeneration activate remodeling
process
Stabilize joint but loss of mobility

22. MUSCLE AND LIGAMENT
FUNCTION
PROPERTIES
Bahaa
Ali
Kornah-AlAzhar
Un.
Cairo
EGYPT

23. LIGAMENTS
Decrease IV height
Increase Elastin: collagen
Increase crosslinks of collagen
Decrease strength and elasticity of ligament.

24. Increase in thickness due to remodeling
Folding of ligamentum flavum
Spinal stenosis
Decrease tension of ligamentum flavum

25. Aging of ligaments

26. Pathria grade Facet
arthropathy on axial T2W1
MRI showing:
 grade I, facet joint space is 2 mm or greater, no
osteophytes or possible small osteophytes can
be found (A);
 grade II, facet joint space is 1 mm to 2 mm,
and/or definite small osteophytes can be found
(B);
 grade III, facet joint space is less than 1 mm,
and/or definite moderate osteophytes can be
found (C);
 grade IV, facet joint space cannot be found (bone
to bone), and/or large osteophytes can be found
(D).

27. MUSCLES
Degeneration of sensory end organs
Fatty degeneration in muscle
Tendon degenerate as ligament
Decrease force generation

28.  Goutallier grade on
axial T2W1 MRI
showing:
 grade 0, muscle tissue is normal (A);
 grade 1, streaks of fat occur (B);
 grade 2, less fat than muscle(C);
 grade 3, amounts of muscle and fat tissue
are equal(D); and
 grade 4, less muscle than fat (E).

29. Aging of muscles

30. BIOMECHANICAL CHANGES
1. Creep characteristics of IVD
2. Kinematics of Functional spinal unit FSU
3. Compressive strength of V. body
4. Stress and intradiscal pressure across IVD
5. Load sharing

31. 1-CREEP CHARACTERISTICS OF IVD
Non Degenerative
Uneven stress
distribution
Attenuates decrease
shock absorption
Deforms fast
Degenerative
Load
Viscoelastic property and
regain back normal space
Creep slowly
Load

32. Temporal change in the
displacement of an
intervertebral disc under a
constant load (i.e., creep)
with different stages of
degeneration. As
degeneration worsens, two
effects are observed:
a) the final displacement increases
and
b) the rate of deformation
increases significantly, in particular,
immediately after the load is
applied

33. 2- KINEMATICS OF FSU2
 Degenerative
 Spread out even out side FSU
Non Degenerative
IAR and ROM due to ligament, facet, IVD changes
lead to hypomobility, hypermobility, immobility or
paradoxical motion
Spontaneous fusion
Decrease in advance IDD
ROM increase in initial IDD
Small area in posterior
aspect of FSU
Axis of rotation
instant axis of rotation

34. In a normal FSU, the
instantaneous center of
rotation (COR) stays
within a narrow region
in the posterior aspect of
the FSU
• In the case of a
degenerated disc, the
COR may vary over a
wide area, even
outside the FSU

35. 3- COMPRESSIVE STRENGTH OF
VERTEBRAL BODY
Decrease bone mineral density
Decrease maximal compressive
strength at central region.
Thinning of cortical bone.
Increase risk of vertebral fracture

36. COMPRESSIVE STRENGTH OF
VERTEBRAL BODY
Anterior wedging
change Center of gravity
forward Flexion posture
Hard to compensate by muscle and ligament alone.

37. 4- STRESS AND INTRADISCAL PRESSURE
ACROSS IVD
Nucleus dehydration
Increase pressure on annulus and loss of
height
Decrease intradiscal pressure
Decrease tension in annulus, load transfer
and compression throughout annulus

38.  The nucleus carries the
compressive loads and
the annulus the tensile
stresses.
 This changes with
degeneration when the
hydration of the disc is
less and the tensile
stresses in the collagen
fibers of the inner
annulus become
compressive stresses.
Disc under pressure adapted from Shirazi-Adl et al.

39. Comparison of the stress profiles
between a normal and
a degenerated disc.
• In a normal disc, a plateau in the
stressprofile is observed whereas,
in the degenerated disc, spikes
are seen in the annular regions
and diminished stress profile is
observed inthe nucleus pulposus.
Modified and adapted from McMillan, D.W., McNally, D.S., Garbutt, G. & Adams, M.A. Stress distributions inside
intervertebral discs: the validity of experimental “stressprofilometry’.Proc Inst Mech Eng H 210, 81-87 (1996).

40. Decrease of intradiscal pressure with increasing grade
of disc degeneration. The pressure measurements were taken in
the prone body position. Horizontal and vertical refers to the alignment
of the pressure-sensitive membrane of the pressure sensor.45
Modified and adapted from Sato, K., Kikuchi, S. & Yonezawa, T.In vivo intradiscal pressure measurement in
healthy individuals and in patients with ongoing back problems. Spine (Phila Pa 1976) 24, 2468-2474 (1999).

41. 5 -LOAD SHARING
Increase compressive load on
neural arch
Bone loss and hypertrophy in
facet and pars interartcularis
Load distribution alter
Increase loading of annulus and
facet joint

42. Effects of lumbar disc degeneration on compressive
load sharing. In a normal disc, the neural arch resists only 8% of
the applied compressive force, and the remainder is distributed
between the anterior and posterior aspects of the vertebral body.
Disc degeneration forces the neural arch to resist 40% of the
applied compressive force, whereas the anterior vertebral body
resists only 19%

43. Clinical
relevance

44. Spinal Stenosis

45. Osteoporotic Compression Fractures

46. Degenerative Spondylolisthesis
Bahaa
Ali
Kornah-AlAzhar
Un.
Cairo
EGYPT

47. Degenerative Adult Scoliosis

48. Developmental DDD

49. A. Physical:
 Posture:
 Splinting
 Body language
 Gait:
 Antalgia
 Heel / Toe pattern
 Trendelenburg
 Musculoskeletal:
 ROM
 Leg length
 Vascular
 Atrophy

50. a.Scoliosis
b.Kyphosis
Saggital & Coronal
Imbalance
Adult Spinal Deformity

51. DIAGNOSTIC MODALUTIES

53. HOW CAN PHYSIOTHERAPY HELP?
• Cannot Treat Condition But Can Treat
Symptoms And AvoidComplication
• Maintenance Phase And Prevent From
Worsening
• After Surgery
• Preventive Physiotherapy

54. REFERENCES
1. THE AGING SPINE : NEW TECHNOLOGIES AND
THERAPEUTICS FOR OSTEOPOROTIC SPINE (
JOSEPH M. LANE , MICHAEL J. GARDNER, JULIE T.
LIN, ELIZABETH MYERS)
2. BIOMECHANICS OF AGING SPINE: ( STEPHEN J.
FERGUSON, THOMAS STEFFEN)
3. SPINE BIOMECHANICS ANDAGE (AKASH
AGARWAL, VIKAS KAUL, VIJAY K GOEL)

55. REFERENCES
4. PATHOPHYSIOLOGY AND BIOMECHANICS OF
THE AGING SPINE (MICHAEL PAPADAKIS,
GEORGIOS SAPKAS, ELIAS C. PAPADOPOULOS,
PAVLOS KATONIS)
5. THE AGING SPINE (NDRNNIGELKELLOW)
6. AGE ASSOCIATED CHANGES IN INNERVATION OF
MUSCLE FIBERS AND CHANGES IN MECHANICAL
PROPERTIES OF MOTOR UNITS (LUFFAR)
7. EXERCISE AND PHYSICALACTIVITY FOR OLDER
ADULTS ( WOITEK J. CHODZKO – ZAIKO , DAVID N
PROCTOR)
8. WEB ( PHYSIOPEDIA)

56. Bah
aa
Ali
THANK YOU
bkornah@hotmail.com

57. THANKYOU!