It used to be that for older people with chronic spine-related health problems, surgery was not an option.  Doctors simply did not want to operate on patients at greater risk for complications.  So, people suffering from spine problems, especially stenosis – a common age-related condition that causes leaden legs – had to live with them, at a serious cost to their quality of life.

In fact, that’s still the case now.  Many doctors continue to shy away from spine surgery for older patients.  Not true at Henry Ford Hospital in Detroit, where an innovative “Elderspine Surgical Program” provides seniors with choices they may not find elsewhere.

“The population…is getting older,” said Dr. Marilyn Gates, director of the program.  “So there is a huge segment that was being left out, for not very viable reasons.”

Gates set out to change that four years ago, when she proposed a business plan to create what is now a successful program centered around spine surgery for seniors. 

Her approach differed from that of colleagues dealing with a younger population.  Gates sought to identify older surgery candidates more readily, risk stratify them, and mold a strategy for each patient not founded on what instrumentation – nuts and bolts – might be put in the body, but on individual patient goals.

“I want to be able to work in the garden” and “I want to walk around the block” are frequent requests Gates hears.  To most people, that may not sound like much, but it’s a world of difference to a previously active – but now housebound – senior. 

“Going in and just relieving some of that pressure with a relatively small surgery can be a huge thing for being more active and feeling better,” said Gates.  “It’s something you can get up and recover from fairly quickly.”

To evaluate whether spine surgery is possible and will help patients reach their goals, Gates and her team use “shared-decisionmaking.”  The patient is not simply told what should be done to his or her body, rather a conversation takes place, matching up as best as possible the patient’s desires and expectations with surgical options.

“I give them all the options,” said Gates.  “I try to give them an objective look at all the risks and benefits.”  Often the goal of surgery is not to fix a back that’s been in pain for twenty years, she said, but to alleviate a new problem that’s cropped up, such as stenosis.  Unlike the goal for a much younger patient, where a larger procedure that fixes both problems is a likely outcome, the patient knows going in that he or she will still have back pain.  Compromise plays a big role in many of the decisions.

The program is paired with a research study that seeks to identify risk factors in older patients.  The ongoing research gives patients more accurate information about anticipated outcomes, and aids in developing future surgical solutions for seniors.

There is also an important education component, Gates said.  Participants receive a notebook with information such as what to expect with spine surgery, possible risks, medication interactions, and who will be part of their surgical team.  In addition to a roster of doctors, nurses, rehabilitation therapists, a case manager and more, each participant selects a “personal recovery coach” who helps the patient through the process.  This can be a family member, friend, or someone else who is willing to see the participant through the surgery.

Patients also participate in an ElderSpine Surgical Education Class that covers what to expect before and after surgery.  The personal recovery coach is encouraged to attend the class as well.

Gates is proud of the many enhancements patients encounter during their typical three to five-day stay following surgery: nutritional support geared toward seniors, private rooms, special lighting on the floors, and big clocks with big numbers so that everyone can tell what time it is, minimizing disorientation.  The idea is to make the patient as comfortable and in-control as possible, making for a faster and more complete recovery.

The program took a lot of planning, and a great deal of collaboration between disciplines at Henry Ford, Gates said.  People were personally dedicated to making the program a reality, with many of them meeting outside of the hospital, after hours.  And in Gates’ estimation, it’s worth it.

“There’s nothing more exciting for us than when somebody comes in and they just are so excited because they’re better,” she said.  “I mean, how can you argue with that?”

For quick tips to keep your spine healthy, click here.