Definition
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:
Pathology
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
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.
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