Back surgery for elders. What are considerations for someone this age and what can we expect for recovery?

Tooyoungforthis. Thank you for your answer and introducing the subject of MILD. I had not previously heard about it and did a quick search. It certainly sounds as though it is a promising new proceedure. But like all new proceedures I approach the concept with caution. My husband spent his entire career as a physician in the pharmaceuical industry working for top name comapanies and from experience knows the bumps in the road all new drugs and devices experience even after many clinical tials and FDA approval so I personally would not rush into this treatment. A few days ago I had a proceedure (Radiofrequency neurolysis) to disable nerves in my back for spinal stenosis so can report that the actual proceedure is tolerable and sounds similar to a MILD proceedure in discomfort level.
At age 76 anytime I have outpatient proceedures of similar intensity it does take a lot longer than one would expect to recover so would avoid major surgery if at all possible.
To sum up my best advice would be to explore all non surgical treatments first and follow instructions for PT etc - no slacking- choose your surgeon carefully not just for their surgical skill but how they relate to the needs of an aging patient ( as soon I hear "age related' I am out the door) I realize we all wear out and I expect that but if my car needs a new fuel pump I expect that to be replaced unless it can be shown that doing it will cause the car to explode. We live in a throw away society but that does not include the aged.
Make sure your surgeon is experienced and has done many of these proceedures, is board certified in his specialty and has a low infection rate. Also choose a facility with a good reputation even if you have to travel a distance again that had excellent infection control. Remember infection control starts at the front door. Is the waiting room clean? Do staff wash their hands? Are the restrooms spotless? Paper towels and TP plentifull. Automatic towel soap and hand sanitizer dispensers. Are the staff in clean uniforms, this includes the Dr in a white coat or scrubs not in his street clothes (I don't care how important he thinks he is)
As you can see I am getting to be a picky bitchy old lady these days. Well you need to be. lat week i di not see the LPN wash her hands or use sanitizer before putting on gloves then she could not work the INR/PT meter "Oh I have not used this in so long I am not sure" two stabs later she got another nurse. After one stab at the IV"please don't put it in the back of my hand it hurts" it hurt - she got another nurse. I am pretty pain tolerant so don't yell but have a memory like an elephant!!!!!!!!!!!!!! as I have said several times before educate yourself and advocate for your elders. Insist on staying while they are preped for anything mo being pushed into the waiting room during the prep stage, they will feel more comfortable with you at their side. Rant over, guess this was the wrong thread for that.

My father was 83 and in good health when he had a cervical laminectomy with fusion. He had lost some use of his left arm and the surgery was performed to stop any permanent damage. My dad was active, no heart issues, no HBP, no diabetes. He died 3.5 years later of complications from a staph infection. He never fully recovered. I went to the rehab facility 10 days post surgery to bring him home. His doctor was baffled why he wasn't improving. A tech ran in yelled STAPH! Dad was whisked off by ambulance back to surgery. Two months later he developed C-Diff while in rehab facility. We could have let him go at this point but he was SO determined to make it and would NOT sign a DNR. A ileostomy was performed. I saw him have adverse reactions to anesthesia (after 2nd surgery) and medications. Nine months later dad made it home. Back surgery unsuccesful. His kidneys shut down for 7 months and he went on dialysis. I remember that poor soul being transferred from nursing home then his home on a stretcher back and forth to dialysis. He never complained. He was thankful. He appreciated all the care he was given. Caring for him almost killed my mother. She developed a staph infection after she came home from hip replacement 6 weeks before his 1st surgery. Staph entered through blisters from allergy to surgical tape. She didn't have any problems with the her antibiotic (vancomycin). No matter what age and state of health there is always the risk of infection. I pray that you and your family find wisdom in your decision.

As a certified registered nurse anesthetist, I know for a fact that general anesthesia causes cognitive problems in the elderly. The longer they are under general anesthesia, the greater the cognitive decline. My 80 year old mother had general anesthesia for 2 rather large surgeries in 2009, and she was never the same after that. She is good for her age right now, but I did definitely notice that she developed a loss of short term memory that never went away.

There are many far less invasive treatments for lower back pain, and surgery should be the very last option. If she has only been having pain for a few months, it is worth it to look into spinal epidural steroids, and something called a "M.I.L.D." procedure (minimally invasive lumbar decompression). In some states, it is covered by Medicare. In some states it was not approved for Medicare reimbursement yet. It is a VERY effective treatment, done under light IV sedation, & a one-day, ambulatory procedure with not much pain afterward.

Surgery should always be the last option, for anything. The fewer doctors you see & the least amount of time in a hospital you can spend is the best way to live. And I am saying this as a medical provider.

My dad, who was somewhat disabled by a stroke, fell while trying to get into the car. He began to have back pain of increasing severity. After a few weeks, he began to lose weight as a result of the pain affecting his appetite. He went to a back specialist who suggested a minimally invasive procedure where a substance was injected into his spine under ultrasound guidance to separate the affected disks and relieve pressure on the nerve. We were concerned because of his age (early 80's) and his stroke related disability, but we saw it as a quality of life issue. He came through the procedure fine, and I took mom to lunch and to run a couple of errands while the hospital staff got dad moved from the recovery room to a room and settled in. When we got back to the hospital I was amazed. Dad was sitting up in a chair and his face was noticeably relaxed. The pain relief was immediate. He suffered no cognitive effects from the anesthesia. The procedure was definitely the right thing to do.

My mom, already suffering from mild to moderate dementia, had surgery to repair her broken ankle, and the anesthesia greatly increased her confusion, but the effect was relatively short-lived. The pain meds following surgery were also an issue. It took six to eight weeks before she was back to her pre-surgery level.

If your MIL is in a lot of pain, it may be worth the risk to have the surgery.

I'm assuming this disc is an L disc? All I can say is I had a massive L4 rupture a year and a half ago. Ran through all the heat/ice/stretch/pain meds/lidocaine patches/steroids/ nerve injections. Nothing worked. Pain was awful, there was just no way to lay to get any sleep, sciatic nerve was being mashed so bad. Pain shot from lower back down butt, through hip joint, down back of thigh, around outer calf, to top of foot. It was excruciating. I wanted to cry the entire 3-1/2 months prior to surgery, would have let them cut off the leg to get it to stop at that point. I had microdiscectomy, the pain was gone the minute they stood me up after surgery. Recovery pain was nothing compared to the pain of the nerve being mashed like that. A rough couple of weeks of course, but after what I'd been through I much preferred the surgery pain to the nerve pain. Sounds like hers is being mashed by vertebrae rather than disk? Has she had a consult with the neurosurgeon that would do the procedure? If not I'd go to that with her to voice concerns, ask questions, weigh the benefits with the risks. I don't know how severe her pain is, but I'd rather have died than continue on like that, (seriously), so I went ahead, and I had a great outcome. Make sure you get a good surgeon and that you understand everything and are comfortable with him. My Doc that picked my surgeon has been my Doc since I was 8 years old, so I had lots of confidence in him. I did read other places that you want a neurosurgeon and not an osteo to do the procedure.

As an RN, I would just say, remember to ask about local anesthesia or spinal anesthesia. I do not believe these would affect brain functioning down the road. My 89 yr old Mom had an emergency hip replacement 5 years ago, so at 84 with general anesthesia. And, yes....just as I am reading this, I realize that two years after this, we noticed enough changes in her to get the neuro psych eval and to learn she had early Alzheimer's. In the years since, she is declining more rapidly each year. Now, my Mom had a back fracture two years ago, and doctor refused to do ANY surgery on her spine then, due to severe osteoporosis. He said her spine would be like powder and no assurance, as compared to the risks, that he could do a repair that would be good. So she got PT and a walker for 3 months but she is now still 'going' and 'going'....So for spinal surgery, I would also be sure to assess for osteoporosis or ask about that if part of the history.

My mom was 83 and had dementia when she needed to have her hip replacement revised so she could walk. I insisted upon the use of a spinal block and mild sedation for the surgery, and she came out of it without any significant worsening of the dementia. I too was very worried about the effect of the anesthesia on her dementia, but the surgery allowed her to walk and the quality of life benefits definitely were worth it. Obviously everyone reacts differently, but I think general anesthesia is a bigger culprit when it comes to increasing/causing dementia after surgery.

I understand the concerns here but it can bring some relief. Mom is 81 with COPD and has had major back problems and gall stones. End of January she had her gallbladder removed. Went home and one month later the back is still killing her. This had gone on for 6 months prior and the doc just pretty much got her hooked on pain killers. After being admitted in February they actually drugged her up enough to get a good MRI of her back. T8-T11, upper back is fractured due to Osteo. The lower spine is sqeezing her nerve at L2-L4, lower back. They can do repairs on the top and considering how much pain she'd been in she agreed to have it done. They put 8 balloons in her upper spine to relieve the fracture. She's now been in a rehab facility trying to get back to her home. They can't do anything to relieve the lower half so she is still on pain killers but it's either that or be in constant pain. I know it's scary putting them under at their age but if it brings some relief then I believe it's worth the effort. I wish you luck in making the decision but everyone knows if the pains is bad enough you'll try anything.

I know I'm just piling on top of the answers you've already gotten, but please consider the risk of dementia. The medical team doesn't. They see a patient as the condition they're 'fixing' and often ignore the risks to quality of life; I think, because they don't deal with the aftermath. My FIL, who was completely sharp mentally, had surgery at 79 and quickly declined cognitively immediately following. His surgeon considered his case a 'success'. The problem was fixed. However, he was discharged to a nursing home and died shortly thereafter.

To add to the chorus, I do hope your mom would consider other methods before surgery. Has she tried injection shots? My personal, non-medical belief is that the surgery hastened my dad's cognitive decline, he just wasn't the same after the surgery (78 years old). He broke his hip so we didn't have an option. I hope she will consider getting a second opinion from another doctor.

My mom had hip replacement at age 83 . She is diabetic among other health issues. I was against it at first but after reading a lot and talking to other caregivers I became more at ease about it. After surgery and a month of rehab she is home and more active than she has been in years. It was not easy. It took a while to get all the meds regulated , especially her slight addiction to pain pills but overall it was a success. Of course each case is different, but apparentlybits not uncommon these days for elders in their 80s to have major surgical procedures.

You should research the possibility of her developing dementia as a result of the anesthesia. My mom had a hysterectomy when she was 80 because of uterine cancer. Following the surgery her cognition changed drastically. While she had signs of dementia before the surgery, her memory seemed to decline rapidly in the months following. Was it because we paid more attention while she was sick? Or was there really a significant decline? We will never be able to answer that question.

Mom's hubby had a hip replaced atthe age of 83 which was followed by about three months of rehab. We were all concerned about the cogitive difficulties that he had following the surgery. He did bounce back to where he was before the surgery within a few weeks.

Anesthesia can have a profound effect on cognition, especially in the elderly and it is unpredictable. Rehab will most definitely be required as the elderly take much longer to regain their level of activity. What is a quick recovery for someone in their 50's or 60's is not going to be the same as for someone in their 80's.

Since she is caregiver for her husband it would be best if facilities for his care are shopped for now, as she may very well not be able to provide for his care following the surgery. Think this through very carefully.

There are risks involved with sugery at any age and of course anesthesia carries it's own risks. That being said a healthy 80 year old should do just fine and the surgery will improve her quality of life. It can probably be done using spinal anesthesai and a heavy sedative. Recoverery in the elderly does take longer so plan help for a minimum of 6 weeks or longer. if she is doning really well you can back off sooner. Could FIL be placed in a facility for a few weeks while she recovers ? Ask the surgeon about lazer surgery. I have no experience but would personally consider that.
By the way I had a hip and knee replacement at age 68 and 9 years later they are both functioning well and I do not (to my knowlege) have dementia. If there is already a tendency it is quite possible that anesthesia may hasten the symptoms that were previously hidden.

Amen to JimmyW's response.

Mom's prosthetic hip wore out but her doctor said the elderly don't come through surgical anesthesia well so we did not have it repaired. Plus there are other risk factors with surgery at that age.

You might want to get a second opinion anyway, from a non-surgical practitioner. I had a disk injury and it healed itself, after a great deal of pain of course, with only a five percent disability.

Good luck and God bless.

My wife had a hip replacement at age 65. No dementia signs prior to surgery. 6 months after surgery the signs of dementia started to show up. I have always (however, I am not a medical person)felt that the anesthesia was involved in the start of her current condition - Alzheimers. If I had to do it again, I would try all other methods before I would try surgery.