What is Spondylosis? Causes and Treatment
Spondylosis is a broad term that simply refers to some type of degeneration in the spine. Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although ageing is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may affect the cervical (neck), thoracic (mid-back), or lumbar (low back) regions of the spine.
Spondylosis Is a Descriptive Term
As with many other terms to describe spinal problems, spondylosis is more of a descriptive term than it is a clinical diagnosis. Literally it can be translated to mean that one has both pain and spine degeneration, regardless of what is causing the pain or where the degeneration is occurring.
How spondylosis can affect the spinal column:
As people age, certain biochemical changes occur affecting tissue found throughout the body. In the spine, the structure of the intervertebral discs (annulus fibrosus, lamellae, nucleus pulposus) may be compromised. The annulus fibrosus (eg, 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 annulus fibrosus. Collagen fibers form the nucleus along with water and proteoglycans. The degenerative effects of aging can weaken the annulus fibrosus’ structure, causing the ‘tire tread’ to wear or tear. The water content of the nucleus decreases with age affecting its ability to rebound following compression (eg, shock absorbing quality). The structural alterations from degeneration may decrease disc height and increase the risk for disc herniation.
Facet Joints or Zygapophyseal Joints
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 that enable 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 and low-friction gliding surface. Facet joint degeneration causes loss of cartilage and formation of osteophytes (eg, bone spurs). These changes may cause hypertrophy or osteoarthritis, also known as degenerative joint disease.
Bones and Ligaments
Osteophytes (eg, 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 or hardening of the bone under the end plates. Ligaments are bands of fibrous tissue connecting spinal structures (eg, vertebrae) and protect against the extremes of motion (eg, hyperextension). However, degenerative changes may cause ligaments to lose some of their strength. The ligamentum flavum (a primary spinal ligament) may thicken and buckle posteriorly (behind) toward the dura mater (a spinal cord membrane).
Spondylosis Symptoms and Different Spinal Levels
The complexity of the cervical (neck) 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 into the shoulder or down the arm. When a bone spur (osteophyte) causes nerve root compression, extremity (eg, arm) weakness may result. In rare cases, bone spurs that form at the front of the cervical spine, may cause difficulty in swallowing (dysphagia). We have an article that presents a cervical spondylosis case; you should definitely read it if you have spinal osteoarthritis in your neck.
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 perextension.
Lumbar (Low Back)
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 (eg, 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 annulus 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 (eg, manual labor) may increase pain.
Causes of Spondylosis
Aging is the predominant cause of spondylosis, also known as spinal arthritis. We put our bodies through a lot of stress and strain every day, and over the years, this can change the various structures of the spine. Even before you experience the symptoms of spondylosis—pain and stiffness, for example—your joints and other spine structures are degenerating (that means wearing out).
Cause and Effect Scenario
You should think of the causes of spondylosis as a “cause and effect” scenario. The main cause is aging, but the way aging affects your spine can lead to other changes and problems. Spondylosis is a cascade: One anatomical change occurs, which leads to more degeneration and changes in your spine’s structures. These changes combine to cause spondylosis and its symptoms.
Degenerative Disc Disease
Generally, the first part of your spine to wear out are your intervertebral discs. For this reason, patients with spondylosis often also have degenerative disc disease (DDD). The effects of these 2 spinal conditions are very related.
The changes begin in your discs, but eventually the process of aging will affect the other motion segments of your vertebrae. (The discs and the facet joints are considered the motion segments, which means that they help you move.) Over time, the collagen (protein) structure of the annulus fibrosus (that’s the outer portion of the intervertebral disc) changes. Additionally, water-attracting molecules—and hence water—in the disc decreases. Both of these changes reduce the disc’s ability to handle back movement.
Through degeneration, the disc will become less spongy and much thinner. A thinner disc means that the space between the vertebra above and below the disc gets smaller, which causes a new problem, this time with the facet joints. They help stabilize the spine, and if the disc loses height, the way the facet joints move changes. Then the cartilage that protects the facets begins to wear away, perhaps causing irritation and inflammation of spinal nerve roots. Without the cartilage, the facet joints start to move too much: They “override” and become overly mobile.
Abnormal Spinal Movement
This hypermobility causes another change in your spine. It tries to stop the movement with the growth of small bony elements called bone spurs (osteophytes). Unfortunately, the bone spurs sometimes pinch nerve structures and cause pain. The bone spurs can narrow the space for the spinal cord and nerves—that disorder is called spinal stenosis. Degenerative disc disease won’t cause spinal stenosis in everyone, but it’s something you should be aware of if you have spondylosis.
Role of Genetics
Your genes can also cause spondylosis. You may be pre-disposed to excessive joint and disc wear and tear, so if someone in your family has or had spondylosis, you may also develop back or neck pain related to spondylosis.
Finally, the way you’re living could lead to spondylosis. Smoking, for example, adversely affects your discs and can cause them to degenerate faster. Smoking actually decreases the amount of water in your discs, and water is part of what helps your discs absorb movement. With less water content, your intervertebral discs can wear out sooner.
A thorough physical examination reveals much about the patient’s health and general fitness. The physical part of 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.
- A neurologic evaluation assesses the patient’s symptoms, including pain, numbness, paresthesias (eg, 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 they are not as useful as a CT scan or MRI. A CT scan may help reveal bony changes sometimes 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. The results from the examination provide a baseline from which the physician can monitor and measure the patient’s progress.
Nonsurgical treatment is successful 75% of the time. Some patients may think because their condition is labelled “degenerative” they will not be able to be active. 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. A soft cervical collar may be used to limit movement and alleviate pain. Lumbosacral (low back, sacrum) orthotics may decrease the low back load by stabilizing the lumbar spine.
A course of physical therapy may include heat, electrical stimulation, and other modalities to help ease muscle spasm and pain. During physical therapy, the patient learns how to strengthen their paravertebral (back) and abdominal (stomach) 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 (eg, from manual labor), losing weight, and quitting smoking.
Seldom is surgery performed to treat spondylosis. Most patients respond well to nonsurgical treatment for spinal osteoarthritis.
If the patient experiences a neurologic deficit (such as bowel or bladder problems), surgery may be considered. The doctor considers many factors about the patient’s health before surgery is recommended. Some of these factors include the patients age, lifestyle and severity of the patient’s spinal disorder. A spinal specialist can determine if surgery is the best treatment for the patient.
Always follow the instructions provided by the doctor or physical therapist. This includes:
- Take medication as directed. Report side effects immediately to your doctor.
- Follow the home exercise program provided by the physical therapist.
- Avoid heavy lifting and activities that aggravate pain and symptoms
- Maintain a healthy weight.
- Stop smoking.
- If symptoms persist or change, contact your doctor.
Discuss questions or doubts you have about modifying your daily activities with your doctor or physical therapist. He or she will be happy to provide information to help speed recovery.
Please let us know if you have any questions and do leave a comment
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