Should a patient with a history of senile spondylosis be admitted to the hospital?

Hospital Admission for Senile Spondylosis

A patient with senile spondylosis alone does not require hospital admission unless they present with severe or progressive myelopathy, significant trauma from a fall, inability to ambulate safely, or acute neurological deterioration.

Clinical Decision Framework

The admission decision hinges on distinguishing between three clinical scenarios:

1. Uncomplicated Cervical Spondylosis (No Admission Required)

Patients with chronic neck pain, stiffness, or mild radicular symptoms without myelopathy can be managed outpatient. 1

• The natural history shows that approximately 70% of patients with mild cervical spondylotic myelopathy maintain stable clinical status over 3 years with conservative treatment 1
• Younger patients (under 75 years) with mild symptoms (modified Japanese Orthopaedic Association score >12) rarely experience acute objectively measurable deterioration 1
• Outpatient management includes activity modification, neck immobilization, NSAIDs, and physical therapy 2, 3

2. Cervical Spondylotic Myelopathy Requiring Admission

Admit immediately if the patient exhibits any of the following:

• Gait disturbance or balance difficulties - this indicates established spinal cord compression requiring urgent neurosurgical evaluation 4
• Progressive weakness in the legs or arms - suggests ongoing cord injury that may become irreversible 4
• Severe weakness limiting self-care or mobility 4
• Bowel or bladder dysfunction 4
• Rapid neurological deterioration 4

Critical pitfall: Do not delay surgery waiting for "failed conservative management" in patients with established myelopathy and gait disturbance, as this risks permanent neurological deficit that cannot be reversed even with eventual decompression 4. Long periods of severe stenosis cause demyelination of white matter and may result in necrosis of both gray and white matter 1, 4.

3. Fall-Related Injuries in Elderly Spondylosis Patients (Selective Admission)

Elderly patients with spondylosis who present after a fall require risk stratification:

• Admit if: Unable to rise from bed and ambulate steadily out of the ED, severe injury occurred, loss of consciousness, or patient safety cannot be ensured at home 1
• High-risk injuries requiring extensive workup include: Blunt head trauma, spinal fractures, and hip fractures, which may present without classic signs in geriatric patients 1
• Discharge with expedited outpatient follow-up if: Patient can safely ambulate, no high-risk injuries identified, and home safety can be ensured 1

Specific Red Flags Mandating Admission

• Syncope during evaluation - requires hospitalization for cardiac workup if suspected cardiac etiology, especially with abnormal ECG or structural heart disease 1
• Orthostatic hypotension with recurrent falls - may require admission for medication adjustment and safety assessment 1
• Age >75 years with moderate-to-severe symptoms - higher risk of acute deterioration 1

Outpatient Management Algorithm for Stable Patients

For patients discharged home:

• NSAIDs as first-line treatment for pain and stiffness 1, 3
• Neck immobilization with cervical collar for acute flares 2
• Physical therapy focusing on neck stabilization and range of motion 5
• Neurosurgical referral within 1-2 weeks if any radicular symptoms or mild myelopathy present 5
• MRI if symptoms persist beyond 4-6 weeks or neurological symptoms develop 5

Common pitfall: Do not rely solely on imaging findings for admission decisions, as spondylotic changes correlate poorly with symptoms and are common in asymptomatic individuals over age 30 5. The clinical examination—particularly gait assessment and neurological function—determines the need for admission 1, 4.