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Cervical spine fusion in a 92 year old
My Dad is 92 with no significant cognitive or health issues. He lives independently and has minor aches and pain (me too). He is pretty sedentary since my mother passed last year following a long battle with dementia, but he shops for himself and visits family and friends. Within the last year, his gate has deteriorated to a shuffle, and he uses a cane for support. After several months of prolonged neurological evaluations, a spinal MRI showed stenosis at C2-3, 5-6 and 6-7. The orthopedic surgeon said this was likely the cause of his gate issues and suggested posterior spinal fusion that should help his issues from getting worse. He said therapy would not help his situation except as needed post surgery. We are seeking a second opinion, but I am very concerned about the risks of spine surgery, a three day hospital stay and post acute therapy on someone his age. Until the last two years, he had never had anything beyond physicals and blood work. He has never had an ED visit or hospital stay. Dad expressed some concern over the cognitive risks of anesthesia for a long procedure, but is looking to his children to help him decide what should be done. He has Medicare with United managed plan. We are seeking a second opinion on the surgical recommendation, but are looking for anyone with experience in the procedure, and possible outcome for a patient of his age. Thanks for any help the group can provide.
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Wow, 92 years old and so independent is impressive. At 72 years old I had C3-7 fused but it was done anteriorly through my neck by neurosurgeon. The recovery was a breeze compared to my L4-5 posterior fusion but also much less weight bearing. I wore the neck brace the first night but after that only when I was out of bed for the next six weeks. I was only in bed at night to sleep. I was supposed to stay two nights in the hospital but begged to go home after one.
It is right to be concerned about cognitive risks of anesthesia for elderly. I am a retired nurse and the best way to combat the confusion elderly may have is to get them out of bed. Sit in a chair, stay upright and walk, walk, walk, even if it's just in the room.
Since your dad is not needing C3-4 & C4-5, maybe the posterior approach is best. I would definitely get a second opinion for necessity and anterior vs posterior technique - anterior may be faster, maybe slower, just ask. Write your questions done so you don't get rushed or forget.
I was given a pain pill & a muscle relaxer postop for pain management - I was really dizzy. I asked the nurse to skip the muscle relaxer and what a difference. I told my doctor those pills weren't good for elderly or maybe cut the dose in half. I just didn't take those muscle relaxers any longer.
I hope you get the answers you need and your father does well no matter he decides. He sounds amazing.
Kindest regards,
Alexis Casazza
Your dad is correct about anesthesia. The liver detoxifies the drugs and is sluggish in 92 year olds. My grandfather was 92 when he needed emergency surgery. He was totally confused for 6 months then it cleared up. He lived until 96.
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Your dad sounds like he has better health than me at 56! Bless him! 🙂
I have had 2 cervical spine surgeries (ACDF on c5-c6 in 2022 and c6-c7 in 2025) and 1 lumbar surgery (2024) due to stenosis, degenerative disc disease, myelopathy and neurogenic claudication causing many symptoms.
Do you know exactly what is going on in your dad’s c2-c3, c5-c6 and c6-c7? Does he have bone spurs/osteophytes, disc herniations, vertebrae slipping over vertebrae below, etc. that is compressing/flattening his spinal cord (cervical myelopathy)? Does he have radiating pain/weakness/numbness in arms/hands (does he drop things or have worsening handwriting)and any bladder/bowel control issues? I had this and myelopathy is considered spinal cord compression injury that progresses if not stopped with spinal cord decompression surgery. Physical therapy doesn’t help this or stop the progression and spinal injections may not help relieve much inflammation and may add risk to joints/nerves.
I had my cervical surgeries from the front and understand posterior would be more painful since they need to cut muscle).
It is a tough decision but not doing anything will just cause further damage and deterioration of his spinal cord and having surgery adds risk since your dad never had surgery before (you don’t know how he will react to anesthesia). I do feel like I have been somewhat negatively affected by anesthesia (had 6 surgeries in 4 years) and my brain is nowhere as sharp as it was prior to surgery and it also caused me major depression episodes that I have not fully recovered from (add menopause hormone changes to the mix, too, plus living long term with chronic pain).
Good luck making a well informed decision and if you do move to surgery, make sure to check reviews and ratings of surgeons to choose the best surgeon to do the procedure who has had success with treating elderly patients. You don’t want a surgeon who has a bias against treating older patients.
The National Upper Spine Chiropractic Association (NUCCA) trains chiropractors who barely touch their patients: my NUCCA doctor's adjustments have such a light touch that they seem to be magically helping my neck heal all the way from C1 and C2 to the base of my spine. Your father is 15 yrs. older than I am. He has an impressive health history and may also benefit from visiting a NUCCA practitioner before having surgery. My motor vehicle spinal injury is inoperable and incredibly painful, so no regularly trained chiropractor knew how to help. Thus, I became highly motivated to search outside the box and find help. At last, my NUCCA doctor is helping me more than any other doctor has. If you visit the NUCCA website, you'll be able to read about what they do. and if you have any questions, please contact NUCCA at: 952-564-3056 or e-mail at info@nucca.org. The photo on the NUCCA website at nucca.org shows the gentle touch being done around the ear of a patient. Also, attached please find a book describing how prolo-therapy and Platelet Plasma Injections (PRP) also help: they are done by the foremost pioneer in PRP therapy, Christopher J. Centeno, M.D. , who has a clinic in Colorado. He also trains other doctors in PRP. The second half of the book elucidates some of the issues that might sometimes arise after spinal surgeries. Of course, it is up to your doctor and you and most of all, your father, to make the final decision regarding care. Getting a second opinion and even a third opinion is a great idea. It was my long conversation with Dr. Centano's nurse and reading his book that led me to discover and learn so much. Also, it was a miracle that I discovered the NUCCA organization and found a NUCCA doctor in my area who suggested I see her first and then if her skills didn't help me, she advised me to go to Dr. Centano in Colorado. May the Lord, our Divine Physician, bless and keep you and your father. I am not a medical professional, so I credit my Lord for leading me to doctors who can help without surgery. However, your father's spinal issues may do better with surgery. I highly recommend you contacting Dr. Centano's nurse and also conversing with .NUCCA
Craniocervical-Instability-Centano Book 101-v2 (Craniocervical-Instability-Centano-Book-101-v2.11.pdf)