Spondylosis (Spinal Osteoarthritis)
Spondylosis is also known as spinal osteoarthritis. It is common and usually not serious, although it can be quite painful. Spondylosis is a degenerative condition that may worsen as a person grows older. It can affect any region of the spine: cervical (neck), thoracic (upper, mid back), lumbar (low back) or lumbosacral (low back/sacrum). Most patients with spondylosis do not require spine surgery.
Spondylosis can affect the spine’s intervertebral discs (eg, degenerative disc disease) and facet joints. As people grow older, normal age-related cellular changes, coupled with the effects of daily wear and tear can cause or contribute to discs losing normal shape, size, and height. These structural alterations may reduce the amount of space (disc space) between vertebral bodies and subsequently affect normal movement of the facet joints. Bone spurs (osteophytes) develop, which can pinch a spinal nerve root and cause inflammation and pain.
Spondylosis is more common in the neck and low back. The neck is susceptible because it supports the weight of the head throughout a wide range of movement. The low back is at risk because it manages and distributes most of the body’s weight and related structural stresses.
- Pain can result from a bulging or herniated disc that impinges (pinches) a spinal nerve. Nerve compressed in the neck may cause neck pain that may radiate downward into the shoulder, arm and hand. Similarly, if the low back is affected, the patient may experience buttock pain and sciatica (leg pain).
- Stiffness can occur after periods of inactivity or rest, such as waking up after a nap.
- Paresthesias (abnormal sensations) may develop, such as numbness or tingling.
As mentioned earlier, spondylosis is often associated with aging. However, a genetic predisposition and/or injury may increase a person’s risk of developing spinal osteoarthritis. Patients typically report their first symptoms between the ages of 20 and 50 years, and more than 80% of individuals older than 40 years have radiologic (X-ray) evidence of the condition. Lumbar spondylosis is especially common in people older than 40 years. According to the Arthritis Foundation, spondylosis affects about 75% of individuals over the age of 60 years.
Making a diagnosis
During the physical and neurological examination, the doctor closely looks at the patient’s spine, and range of motion while bending forward, backward, and side-to-side. The doctor notes the shape of the spine, including any abnormal curvatures. He/she palpates (feels) the spine to detect any tender spots, muscle tightness or spasms, bumps, or areas of inflammation. Furthermore, pain is thoroughly evaluated along with other symptoms (eg, paresthesias, weakness).
X-rays may detect bone spurs or loss of disc height. The doctor may order a CT (computerized tomography) or MRI (magnetic resonance imaging) to view degenerative changes and abnormalities in spine’s soft tissues. Of course, depending on the patient’s symptoms, other types of tests may be recommended.
Although spondylosis can be very painful, most patients respond favorably to nonsurgical treatments.
- First-line treatment may include analgesics (pain medications), anti-inflammatory drugs, and muscle relaxants.
- Physical therapy may include ice/heat, massage, and/or ultrasound.
- Stretching and warm-up exercise (as tolerated) helps to ready the patient for active exercise.
- Strengthening exercises can help improve spinal flexibility, build strength and endurance.
- To help reduce pain, you may be admonished to lose weight.
- To prevent pain flare ups, the physical therapist instructs patients how to move without exacerbating pain, which includes how to improve and maintain good posture.
As stated earlier, seldom is spine surgery needed to treat spondylosis that develops in the back or neck. However, in some cases, nonoperative therapies do not provide adequate pain/symptom relief. Nerve compression may become severe and/or the symptoms of spinal osteoarthritis progressively become worse, and/or lead to significant extremity (arm, leg) weakness and numbness. In some cases, a back or neck surgery may be recommended. There are many factors, including the patient’s general health that requires careful evaluation if a spinal procedure is considered.