Bone strength can affect which spine surgery makes sense, how it’s done, and how well the results hold up. That’s the message Coastal Orthopedics spine surgeon Dr. Vincent Federico shared in a Becker’s Spine Review feature on bone health and aging spine care, where he called bone health the biggest blind spot in caring for older spine patients.
Does age decide whether someone can have spine surgery?
Not on its own. Dr. Federico looks at how a person’s body is actually doing, not just the birth date on their chart.
“It’s honestly more like physiological age than chronologic,” he told Becker’s. “We have 95-year-olds who come in who look like they’re 50, and then you have 70-year-olds who look like they’re 90.”
For him, age mainly helps decide where a procedure should happen: a surgery center where patients go home the same day, or a hospital. He also asks every patient who they live with. Someone with help at home for the first week may be a good fit for outpatient surgery. A hospital stay may better serve someone who lives alone with physical therapy before heading home.
Why does bone health matter for spine surgery?
Many spine surgeries use screws, rods, or spacers that need solid bone to hold onto. A systematic review in the North American Spine Society Journal found that low bone density was linked to higher rates of loosened screws, spacers sinking into the bone, and fusions that don’t fully heal. A position statement from the International Osteoporosis Foundation reached a similar conclusion and called for closer teamwork between surgeons and bone health specialists.
Dr. Federico says osteoporosis should shape which surgery a patient gets and how it’s performed. At his practice, fusion patients receive information on vitamin D, calcium, and bone health. People with more than one spinal level fused, especially women, also get a bone density scan.
Why is bone health so often overlooked?
Dr. Federico points to a few reasons. Wait times to see a bone specialist can stretch past a year, and few of those specialists focus on bone health. Many orthopedic groups don’t offer bone health programs. And most people have no idea their bones are weak until something breaks. As he put it, osteoporosis is “silent until it’s not.”
