Osteoporosis and degenerative bone changes predispose the elderly to injury from low-energy trauma. A significant number of injuries occur following falls. Central cord syndrome is the most common incomplete lesion. Compression fractures are the most common bone injuries in the thoracic and lumbar spine. In addition to decreased bone density, pathologic lesions may also be responsible for compression fractures. If a minor mechanism of injury results in a fracture, metastatic disease and multiple myeloma should be excluded as causes. The most important principle of therapy in the elderly is early mobilization and rehabilitation. Prolonged immobilization results in more systemic complications and higher mortality. Decisions involving operative versus nonoperative treatment should take this into account.

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