Back pain in the elderly: updated diagnosis and management.

CT of compression fractures is a useful adjunct to the plain x-ray in excluding signs of metastasis. However, increased bone density on CT may not distinguish osteoporotic fractures from neoplastic disease, in which case radioiodine scan, bone and marrow biopsies, or myelography may be necessary. Surgery for painful osteoarthritic spinal disease is controversial. The potential advantages of surgery must be weighted against the risk of anesthesia, the length and tolerance of postoperative immobility, and the effect of laminectomy and fusion on the biomechanics of the spine. Furthermore, the elderly are at increased risk for postoperative complications.