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Clinical Case Study

A 68-year-old man visited his family doctor for his first physical examination in 30 years. Upon sensing a disgruntled patient, the doctor gently tried to determine the reason. In response to the doctor’s inquiry, the patient blurted out, “The nurse who measured my height is incompetent! I know for a fact I used to be six feet even when I was in the Navy, but she tells me I’m 5’10”!” The doctor then performed the measurement himself, noting that although the patient’s posture was excellent, he was indeed 5′10″, just as the nurse had said. He explained to the patient that the spine contains some nonbony tissue, which shrivels up a bit over the years.

The patient interrupted, stating indignantly that he knew anatomic terms and principles and would like a detailed explanation. How would you explain the anatomy of the vertebral column and the changes it undergoes during the aging process?

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Hints: The patient’s normal posture and the fact that he had no complaints of pain indicated good health for his age. Examine figure 6.32 and carefully read the accompanying caption. Also, think of the possible clinical diagnosis for height loss.

FIGURE 6.32 The vertebral column of an adult has four curves named according to the region in which they occur. The bodies of the vertebrae are separated by intervertebral discs, which allow flexibility.

Clinical Case Study Answer

The height (overall length) of the vertebral column is equal to the sum of the thicknesses of the vertebrae plus the sum of the thicknesses of the intervertebral discs. The body of a vertebra consists of outer compact bone and inner spongy bone. An intervertebral disc consists of a fibrocartilage sheath called the anulus fibrosus and a mucoid center portion called the nucleus pulposus. The intervertebral discs generally change their anatomical configuration as one ages. In early adulthood, the nucleus pulposus is spongy and moist. With advanced age, however, it desiccates, resulting in a flattening of the intervertebral disc.

Collectively, the intervertebral discs account for 25% of the height of the vertebral column. As they flatten with age, there is a gradual decrease in a person’s overall height. Height loss may also result from undetectable compression fractures of the vertebral bodies, which are common in elderly people. This phenomenon, however, is considered pathological and is not an aspect of the normal aging process. In a person with osteoporosis, there is often a marked decrease in height and perhaps more serious clinical problems as well, such as compression of spinal nerves.