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Laureen D. Hachem and Mark Bernstein

practicing neurosurgeon will need to navigate the ethical complexities inherent within the evolving field of geriatric neurosurgery. This paper outlines the main principles of bioethics and highlights how these underlie a number of key ethical challenges faced across the spectrum of neurosurgical conditions in elderly patients. Ethical Principles and Theories The foundation of medical ethics is built on four principle tenets: autonomy, beneficence, nonmaleficence, and justice. Each of these values has unique considerations in the context of geriatric neurosurgery. 2

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Shane Shahrestani, Brandon M. Lehrich, Ali R. Tafreshi, Nolan J. Brown, Brian V. Lien, Seth Ransom, Ryan C. Ransom, Alexander M. Ballatori, Andy Ton, Xiao T. Chen, and Ronald Sahyouni

F railty is defined as a clinically recognizable state of increased vulnerability resulting from age-associated physiological decline, and frail patients continue to be at a higher risk of poor health outcomes, including falls, disability, perioperative complications, readmissions, and mortality. 1–6 The direct relationship between advanced age and frailty makes frailty a particular concern in geriatric and elderly patient populations (≥ 65 years old), especially those receiving complex surgical interventions including cranial neurosurgery. 7–12 However, the

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Diana T. Le, Kinsey A. Barhorst, James Castiglione, George L. Yang, Sanjit J. Shah, Sarah S. Harlan, Shaun P. Keegan, Roman A. Jandarov, Laura B. Ngwenya, and Charles J. Prestigiacomo

common causes of BCVIs in adults were motor vehicle accidents, whereas geriatric patients more commonly presented due to falls from standing height. 7 , 8 With the population of both the United States and the international community aging rapidly, and 1 in every 5 people expected to be older than 65 years by 2030, 9 special attention should be given to the geriatric population. Limited information exists to describe the effects of BCVI on the population of adults older than 65 years of age. Page and Josiah demonstrated that mortality specifically following vertebral

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Pascal Jabbour, Michael Fehlings, Alexander R. Vaccaro, and James S. Harrop

T raumatic injuries to the spinal column and/or spinal cord can result in significant morbidity, disability, and even death. 12 A common misconception is that these injuries occur in isolation and only to adolescents and young adults. However, epidemiological studies on populations with SCIs report a bimodal distribution. 19 The first peak occurs as expected in young adults and adolescents; however, the second peak occurs to the elderly population. Geriatric patients are not clearly defined in the spine literature. For this manuscript, the term will be

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Owoicho Adogwa, Aladine A. Elsamadicy, Victoria D. Vuong, Jessica Moreno, Joseph Cheng, Isaac O. Karikari, and Carlos A. Bagley

D egenerative disorders of the lumbar spine are a major cause of low-back pain and morbidity in the rapidly growing geriatric population in the United States. 13 , 18 , 20 , 22 , 23 Symptomatic low-back and leg pain can lead to loss of function or the inability to perform basic activities of daily living. Surgical treatment for low-back pain historically has been pursued with limited success in elderly patients; however, the need and demand for surgical treatment in this population have been increasing to reduce pain and disability and to increase quality of

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Daniel R. Fassett, James S. Harrop, Mitchell Maltenfort, Shiveindra B. Jeyamohan, John D. Ratliff, D. Greg Anderson, Alan S. Hilibrand, Todd J. Albert, Alexander R. Vaccaro, and Ashwini D. Sharan

It is estimated that 20% of the US population will be older than age 65 by the year 2040. 8 The aging of the baby boomer population is likely to impact spine surgeons and spinal cord rehabilitation centers as older patients account for a larger proportion of the cases of SCI. Geriatric patients are vulnerable to traumatic SCI as a result of a number of factors, including: 1) changes in bone quality with aging, 2) increasing prevalence of cervical spinal stenosis with older age, 3) propensity for fall-related injuries due to loss of neurological reserve

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Ladina Greuter, Katharina Lutz, Javier Fandino, Luigi Mariani, Raphael Guzman, and Jehuda Soleman

age. To date, no studies exist analyzing different operative techniques for cSDH that might affect outcome depending on the patient’s age. It has been shown that older patients have overall worse outcome after surgical treatment of cSDH. 3 Our data showed that patients ≥ 80 years old show higher complication and mortality rates. Hence, optimal surgical treatment is of paramount importance in geriatric patients. The most commonly used method for cSDH treatment is BHD. 5 , 9 BHD was shown to have significantly lower complication rates compared with open craniotomy

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Paul S. Page and Darnell T. Josiah

these studies are relatively young, with an average age of 35 years at the time of their injury. 11 , 12 While these studies were very well designed, the reliability of generalization of their findings to the geriatric population is limited. Many geriatric patients are at greater risk for cervical spine injury than younger patients due to their predisposition for underlying osteopenia and osteoporosis and the difference in their vascular mobility compared to that of their younger counterparts. Overall, close to 23% of traumatic injuries occur in older adults, and

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Elizabeth E. Ginalis and Shabbar F. Danish

G lobal population aging has led to an increase in the geriatric population worldwide. This is in part due to the decrease in mortality at older ages and the consequent increase in life expectancy. In the United States, the number of geriatric people—aged 65 years and older—is expected to nearly double from 52 million in 2018 to 95 million by 2060; specifically, the number of people aged 85 and older will triple during that same time period. 1 At this rate, the elderly population will compose approximately 23% of the total population in the United States. 1

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Mark G. Hamilton, Ian Parney, Odette A. Harris, Eric A. Schmidt, and Howard A. Riina

T he world population of individuals over 65 years old is growing at a very rapid rate and many people are living longer. The 85-and-older population is the fastest-growing demographic and will represent 2% to 3% of the world population in 2030. Many of the conditions requiring neurosurgical treatment in younger patients may be experienced by geriatric or elderly patients, who are also at risk for many disorders unique to older adults. In addition, age-related changes in the physiology of the brain and the central nervous system (CNS), as well as non