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TweetWhat Is Spondylosis?
Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the intervertebral discs and facet joints.
Spondylosis often affects the following spinal elements:
Intervertebral Discs and Spondylosis
As people age certain biochemical changes occur affecting tissue found throughout the body. In the spine, the structure of the intervertebral discs (anulus fibrosus, lamellae, nucleus pulposus) may be compromised. The anulus fibrosus (e.g. tire-like) is composed of 60 or more concentric bands of collagen fiber termed lamellae. The nucleus pulposus is a gel-like substance inside the intervertebral disc encased by the anulus fibrosus. Collagen fibers form the nucleus along with water, and proteoglycans.
The degenerative effects from aging may weaken the structure of the anulus fibrosus causing the 'tire tread' to wear or tear. The water content of the nucleus decreases with age affecting its ability to rebound following compression (e.g. shock absorbing quality). The structural alterations from degeneration may decrease disc height and increase the risk for disc herniation.
Facet Joints (or Zygapophyseal Joints) and Spondylosis
The facet joints are also termed zygapophyseal joints. Each vertebral body has four facet joints that work like hinges. These are the articulating (moving) joints of the spine enabling extension, flexion, and rotation. Like other joints, the bony articulating surfaces are coated with cartilage. Cartilage is a special type of connective tissue that provides a self-lubricating low-friction gliding surface. Facet joint degeneration causes loss of cartilage and formation of osteophytes (e.g. bone spurs). These changes may cause hypertrophy or osteoarthritis, also known as degenerative joint disease.
Bones and Ligaments
Osteophytes (e.g. bone spurs) may form adjacent to the end plates, which may compromise blood supply to the vertebra. Further, the end plates may stiffen due to sclerosis; a thickening/hardening of the bone under the end plates.
Ligaments are bands of fibrous tissue connecting spinal structures (e.g. vertebrae) and protect against the extremes of motion (e.g. hyperextension). However, degenerative changes may cause ligaments to lose some of their strength. The ligamentum flavum (a primary spinal ligament) may thicken and/or buckle posteriorly (behind) toward the dura mater (a spinal cord membrane).
Cervical Spine and Spondylosis
The complexity of the cervical anatomy and its wide range of motion make this spinal segment susceptible to disorders associated with degenerative change. Neck pain from spondylosis is common. The pain may spread (radiate) into the shoulder or down the arm. When a bone spur (osteophyte) causes nerve root compression, extremity (e.g. arm) weakness may result. In rare cases, bone spurs that form at the front of the cervical spine, may cause difficult swallowing (dysphagia).
Thoracic Spine and Spondylosis
Pain associated with degenerative disease is often triggered by forward flexion and hyperextension. In the thoracic spine disc pain may be caused by flexion - facet pain by hyperextension.
Lumbar Spine and Spondylosis
Spondylosis often affects the lumbar spine in people over the age of 40. Pain and morning stiffness are common complaints. Usually multiple levels are involved (e.g. more than one vertebrae).
The lumbar spine carries most of the body's weight. Therefore, when degenerative forces compromise its structural integrity, symptoms including pain may accompany activity. Movement stimulates pain fibers in the anulus fibrosus and facet joints. Sitting for prolonged periods of time may cause pain and other symptoms due to pressure on the lumbar vertebrae. Repetitive movements such as lifting and bending (e.g. manual labor) may increase pain.
Spondylosis Diagnosis
Physical Examination
A thorough physical examination reveals a lot about the health and general fitness of the patient. The exam includes a review of the patient's medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include:
> Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm.
> Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.
Neurologic Evaluation
A neurologic evaluation assesses the patient's symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.
X-Rays and Other Tests
Radiographs (x-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but is not as useful as a CT Scan or MRI.
The CT Scan may be used to reveal the bony changes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities.
Discography seeks to reproduce the patient's symptoms to identify the anatomical source of pain. Facet blocks work in a similar manner. Both are considered controversial.
The physician compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. Further, the results from the examination provide a baseline from which the physician can monitor and measure the patient's progress.
Treatment
Conservative treatment is successful 75% of the time. Some patients may think that because their condition is labeled degenerative they are doomed to end up in a wheel chair some day. This is seldom the case. Many patients find their pain and other symptoms can be effectively treated without surgery.
During the acute phase, anti-inflammatory agents, analgesics, and muscle relaxants may be prescribed for a short period of time. The affected area may be immobilized and/or braced. Soft cervical collars may be used to restrict movement and alleviate pain. Lumbosacral orthotics may decrease the lumbar load by stabilizing the lumbar spine. In physical therapy, heat, electrical stimulation, and other modalities may be incorporated into the treatment plan to control muscle spasm and pain.
Physical Therapy (PT) teaches the patient how to strengthen their paravertebral and abdominal muscles to lend support to the spine. Isometric exercises can be helpful when movement is painful or difficult. Exercise in general helps to build strength, flexibility, and increase range of motion.
Lifestyle modification may be necessary. This may include an occupational change (e.g. from manual labor), losing weight, and quitting smoking.
Surgery
Seldom is surgery used to treat spondylosis or spinal osteoarthritis. Conservative forms of treatment are tried first.
If there is neurologic deficit, certain surgical procedures may be considered. However, before surgery is recommended, the patient's age, lifestyle, occupation, and number of vertebral levels involved are carefully evaluated.
A spinal physician is able to determine if surgery is the best treatment for the patient.
Recovery
Always follow the instructions provided by the physician and/or physical therapist. This includes:
> Take medication as directed. Report side effects to your physician immediately.
> Follow the home exercise program provided by the physical therapist.
> Avoid heavy lifting and activities that aggravate pain or other symptoms.
> Try to keep your weight close to ideal.
> Stop smoking.
Any doubts concerning vocational and recreational restrictions should be discussed with your physician and/or physical therapist. They will be able to suggest safe alternatives to help reduce the risk of further back problems.
If symptoms persist or change, contact your spinal physician.
