Spinal Surgery Options for Elderly Patients with Diabetes

Spinal region

Hello, Doctor: My mother is 75 years old.
She has undergone an MRI and X-rays at a hospital in Taipei.
The doctor informed me that there is a gap between her lumbar vertebrae 4 and 5, and I am unsure if this is related to cartilage; he only mentioned that the material that should be there is missing.
The doctor said that surgery is needed to insert an artificial device and screws, but this procedure would require out-of-pocket expenses.
My mother does not have nerve compression.
Is surgery the only option? I am particularly concerned about the burden of surgery on her due to her age.
Additionally, my mother has diabetes and has a history of kidney stones; she still has stones in her kidneys.
Her heart condition is not very good.
Will the healing of the surgical wound be affected? How long is the recovery period after surgery? How many days would she need to stay in the hospital? Also, what would the approximate costs be? Are there any financial assistance options available for the surgery? Our family's financial situation is not good, and the cost of the surgery would be a significant burden for me, but if surgery is the only option, I would like to proceed for my mother's sake.
I look forward to your answers to the above questions.
Thank you.

Xiao Feng, 30~39 year old female. Ask Date: 2010/03/15

Dr. Shi Guozheng reply Orthopedics

Surgery is not necessary unless there is severe pain.
If there are neurological symptoms and signs of spinal instability, then the use of bone screws for fixation may be required.
The surgery for bone screws must be pre-approved by health insurance, and it can be covered without out-of-pocket expenses.
There are inherent risks associated with surgery, and the more comorbidities a patient has, the higher the risk.
The recovery period after surgery is approximately two to three months, with a hospital stay of about one week.
The costs can be covered by health insurance, and the patient typically only needs to pay a small co-payment, which is usually not high.
Surgery is not the only treatment option for spinal disorders; consulting multiple specialists can provide a better understanding and help in choosing the most appropriate treatment method.

Reply Date: 2010/03/15

More Info

When considering spinal surgery options for elderly patients with diabetes, several factors must be taken into account, particularly in the case of your mother, who is 75 years old and has a history of diabetes and kidney stones. Here’s a comprehensive overview of the considerations and implications of such a surgical procedure.

Necessity of Surgery
In your mother’s case, the recommendation for surgery is based on the findings from her MRI and X-ray, which suggest that there is a significant issue with the intervertebral discs between the fourth and fifth lumbar vertebrae. The absence of the normal disc material could indicate degeneration, which may lead to instability in the spine. While the doctor mentioned that there is no nerve compression at this time, the absence of the disc could potentially lead to future complications, including pain or further degeneration.

However, surgery is not always the only option. Non-surgical treatments such as physical therapy, pain management, and lifestyle modifications can sometimes alleviate symptoms. It is essential to discuss these alternatives with her healthcare provider to understand if they might be appropriate for her condition.

Risks of Surgery
Given your mother's age and medical history, surgery does carry inherent risks. Elderly patients are generally at a higher risk for complications during and after surgery due to factors such as decreased physiological reserve, potential for slower recovery, and the presence of comorbidities like diabetes and heart issues. Diabetes can affect wound healing and increase the risk of infections, which is a critical consideration when planning any surgical intervention.

Impact of Diabetes on Healing
Diabetes can significantly impact wound healing due to impaired blood flow and immune response. If her blood sugar levels are not well-controlled, this could lead to complications post-surgery. It is crucial to ensure that her blood glucose levels are managed effectively before and after the procedure. Ideally, her blood sugar should be maintained below 150 mg/dL, as higher levels can lead to increased risks of infection and delayed healing.

Recovery Time and Hospital Stay
The recovery time after spinal surgery can vary widely based on the specific procedure performed, the patient's overall health, and adherence to postoperative care. Generally, patients may expect to stay in the hospital for a few days, typically ranging from 2 to 5 days, depending on the complexity of the surgery and the patient's recovery progress. After discharge, physical therapy and rehabilitation will be essential for regaining strength and mobility, which may take several weeks to months.

Financial Considerations
Regarding the financial aspect, spinal surgeries can be costly, especially if certain materials are not covered by insurance. It is advisable to discuss with the healthcare provider about potential financial assistance programs or payment plans that may be available. Some hospitals have financial counselors who can assist in navigating insurance coverage and out-of-pocket costs.

Conclusion
In summary, while surgery may be necessary for your mother’s condition, it is essential to weigh the risks and benefits carefully, especially considering her age and diabetes. Engaging in a thorough discussion with her healthcare team about all available options, potential risks, and the management of her diabetes will be crucial in making an informed decision. Additionally, exploring financial assistance options can help alleviate some of the economic burdens associated with the surgery. Always seek a second opinion if there are uncertainties regarding the recommended treatment plan.

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