Spondylosis, often referred to as spinal osteoarthritis, is a degenerative condition that affects the spine. It’s almost universally present in older individuals, representing the cumulative effect of years of use on the spinal structures. However, it’s important to note that spondylosis isn’t exclusive to the elderly and can also develop in younger people due to various factors. While some individuals with spondylosis remain completely asymptomatic, others may encounter a range of symptoms, most commonly stiffness and pain. These discomforts can manifest in various areas, including the neck, shoulders, or between the shoulder blades, significantly impacting daily life.
Decoding Spondylosis: Osteoarthritis of the Spine Explained
Spondylosis is essentially another term for osteoarthritis that specifically targets the spine. This condition is a natural consequence of aging, arising from the gradual wear and tear on the intricate components of the spine. This wear and tear affects both the hard tissues (bones) and soft tissues (discs, ligaments) that constitute the spinal column. As we age, the discs between vertebrae can dehydrate and shrink, losing their cushioning ability. Ligaments can thicken and become less flexible, and bone spurs (osteophytes) may form along the edges of vertebrae. These changes are all hallmarks of spondylosis.
While spondylosis can theoretically affect any region of the spine, it shows a predilection for the cervical (neck) and lumbar (lower back) sections. These areas are naturally more mobile and bear a significant amount of weight and stress, making them more susceptible to age-related degeneration. The thoracic spine, or middle back, is less frequently affected, possibly due to the stabilizing support provided by the rib cage, which limits its range of motion and reduces the impact of daily wear and tear.
Recognizing the Symptoms of Spondylosis: What to Watch For
One of the perplexing aspects of spondylosis is its variability in symptom presentation. Many individuals with radiographic evidence of spondylosis on imaging scans experience no symptoms whatsoever. In these cases, the condition might only be discovered incidentally when imaging of the spine, such as X-rays, MRIs, or CT scans, is performed for an unrelated medical evaluation.
However, when symptoms do arise, they can vary significantly depending on the location and severity of the spondylotic changes, as well as the specific spinal structures involved. The most common symptoms include pain and reduced range of motion. Beyond pain, some individuals may experience crepitus, which is a grating, crackling, or popping sensation or sound within the spine during movement. This often accompanies limited range of motion but is generally not indicative of nerve or spinal cord damage in the absence of other neurological symptoms.
Cervical Spondylosis Symptoms: Neck and Arm Involvement
Cervical spondylosis, affecting the neck region, commonly manifests as neck pain and stiffness. The pain can range from a dull ache to sharp, localized discomfort. Stiffness in the neck can limit the ability to turn the head or tilt it from side to side, impacting everyday activities like driving or looking over your shoulder.
In more pronounced cases of cervical spondylosis, the degenerative changes can lead to nerve compression. When bone spurs or herniated discs in the neck impinge upon the spinal nerves, it can result in cervical radiculopathy. This condition is characterized by pain radiating down the arm, often accompanied by numbness, tingling, and even muscle weakness in the arm, hand, or fingers. The neck pain itself may or may not be a prominent feature in cervical radiculopathy.
In severe instances, cervical spondylosis can compress the spinal cord itself, leading to cervical myelopathy. Spinal cord compression is a serious condition that can present with weakness, impaired coordination, and motor function deficits in the arms and hands. Other symptoms of cervical myelopathy can include gait disturbances, bowel or bladder dysfunction, and sensory changes.
Lumbar Spondylosis Symptoms: Lower Back and Leg Pain
Lumbar spondylosis, affecting the lower back, typically presents with low back pain as the primary symptom. This pain can be chronic and persistent or intermittent, and it may be exacerbated by activity and relieved by rest. Similar to cervical spondylosis, lumbar spondylosis can also lead to nerve compression.
Lumbar radiculopathy occurs when spinal nerves in the lower back are compressed or inflamed, often due to disc herniation or bone spurs. This nerve compression can cause pain that radiates from the lower back into the buttocks, hip, and down the leg. Sciatica, a common form of lumbar radiculopathy, specifically involves irritation of the sciatic nerve, the largest nerve in the body, causing pain that extends down the back of the leg, sometimes reaching the foot and toes. Patients might mistakenly attribute leg pain, even knee pain, to a local injury when it is actually referred pain originating from nerve compression in the lumbar spine due to spondylosis. Tingling, numbness, and weakness in the leg or foot can also accompany lumbar radiculopathy.
Is Spondylosis a Serious Condition? Assessing the Severity
The seriousness of spondylosis is not uniform and varies greatly from person to person. For many, spondylosis is a manageable condition. Conservative treatments like physical therapy, pain relievers, and lifestyle modifications are often effective in alleviating symptoms and improving quality of life.
However, it’s crucial to recognize when spondylosis may become more serious and warrant prompt medical attention. Orthopedic specialists advise seeking immediate medical care if any of the following symptoms, indicative of nerve compression, develop:
- Muscle Weakness: This includes new onset weakness in the arms or legs, or conditions like foot drop, where lifting the front part of the foot becomes difficult.
- Bowel or Bladder Dysfunction: Incontinence (loss of bladder or bowel control) or difficulty with urination or bowel movements can be a sign of significant spinal cord compression.
- Balance Issues: New and unexplained problems with balance and coordination that are not attributable to other causes should be evaluated.
- Numbness: Numbness that follows a stripe-like pattern or involves the fingers or hands may indicate nerve involvement.
- Severe Pain: Intense pain, particularly electrical, shooting, or shock-like pain, is a red flag.
- Unresponsive Pain: Arm or leg pain that persists despite conservative treatments such as physical therapy, oral pain medications, and spinal injections should be further investigated.
These symptoms suggest potential nerve or spinal cord compromise and necessitate timely medical evaluation to prevent further complications.
Risk Factors for Spondylosis: Who is More Susceptible?
Spondylosis is largely considered an age-related condition, and to some degree, it is expected to affect most individuals as they age. The cumulative effect of gravity and daily stresses on the spine over many years contributes significantly to its development.
While aging is the primary risk factor, genetics may also play a role. There is a possibility of a genetic predisposition to developing spondylosis, meaning that individuals with a family history of the condition might be at a slightly increased risk. However, research in this area is ongoing, and a definitive genetic link has not been conclusively established.
Another recognized risk factor is prior traumatic injury to the spine. Individuals who have experienced spinal injuries are more likely to develop spondylosis at an earlier age or with greater severity later in life. Trauma can accelerate the degenerative processes in the spine.
Spondylosis vs. Spondylolisthesis: Distinguishing Between Conditions
Spondylosis and spondylolisthesis are distinct spinal conditions, although their names are similar and can cause confusion. Spondylolisthesis refers to a condition where one vertebra slips forward or out of alignment relative to the vertebra below it. This slippage most commonly occurs in the lumbar spine.
While spondylolisthesis is a separate diagnosis, it can sometimes be a consequence of spondylosis. The degenerative changes in spondylosis can weaken the spinal structures, making them more prone to vertebral slippage and leading to spondylolisthesis.
Other spinal conditions that can arise as a result of spondylosis include spinal stenosis (narrowing of the spinal canal) and foraminal stenosis (narrowing of the nerve root canals).
Diagnosing Spondylosis: Imaging and Evaluation
The diagnosis of spondylosis primarily relies on imaging studies of the spine. Different imaging modalities are better suited for visualizing specific spinal structures:
- X-rays: X-rays are excellent for visualizing bones and are typically the first-line imaging study for spondylosis. They can clearly reveal bony changes such as bone spurs (osteophytes), narrowing of the disc space, and vertebral alignment.
- MRI (Magnetic Resonance Imaging): MRI provides detailed images of soft tissues, including intervertebral discs, ligaments, spinal cord, and nerves. MRI is highly valuable for detecting disc herniations, spinal cord compression, nerve root compression, and ligament thickening associated with spondylosis.
- CT (Computed Tomography) Scan: CT scans combine X-rays with computer processing to create cross-sectional images of the spine. CT scans are useful for visualizing bony details and can be used as an alternative or complement to MRI, particularly when MRI is contraindicated.
Common findings on imaging studies in spondylosis include bone spurs, bulging or herniated discs, facet joint arthritis, and ligament hypertrophy. Importantly, it’s crucial to remember that the presence of these findings on imaging does not automatically equate to symptoms. Many individuals have radiographic evidence of spondylosis without experiencing any pain or discomfort.
To better understand the functional impact of spondylosis, orthopedists may order dynamic X-rays. These X-rays are taken while the patient bends forward and backward, allowing the doctor to assess spinal stability and motion.
Who Treats Spondylosis? Seeking the Right Medical Professional
For initial evaluation of back or neck pain, consulting a primary care physician is usually the first step. They can perform a basic assessment, provide initial pain management strategies, and determine if further specialist referral is necessary.
For persistent pain or symptoms suggestive of nerve compression (weakness, numbness), seeking consultation with a specialist in musculoskeletal medicine is recommended. Appropriate specialists include:
- Physiatrist: A physiatrist, also known as a Physical Medicine and Rehabilitation (PM&R) physician, specializes in the nonsurgical management of musculoskeletal and neurological conditions. They focus on restoring function and improving quality of life.
- Pain Management Doctor: Pain management specialists are experts in diagnosing and treating various types of pain, including chronic pain related to spondylosis. They offer a range of interventional pain management procedures.
- Spine Surgeon: Spine surgeons, typically orthopedic surgeons or neurosurgeons, specialize in the surgical treatment of spinal conditions. They are consulted when conservative treatments fail and surgery is considered.
- Neurologist: In some cases, a neurologist may be involved, particularly if there are concerns about neurological complications or if nerve-related symptoms are prominent.
The specific type of specialist involved in treatment will depend on the individual’s symptoms, the severity of spondylosis, and the treatment approach required. Hospital for Special Surgery (HSS) provides access to a wide range of specialists experienced in treating spondylosis.
Spondylosis Treatment Options: From Conservative Care to Surgery
Treatment for spondylosis is highly individualized and depends on the specific symptoms, the location of spondylosis in the spine, and the severity of the condition. The initial approach is almost always conservative, focusing on non-surgical methods to manage pain and improve function.
Conservative Treatments:
- Physical Therapy: Physical therapy is a cornerstone of spondylosis treatment. It aims to strengthen the muscles supporting the spine, improve flexibility and range of motion, reduce pain, and educate patients on proper posture and body mechanics.
- Pain Medications: Over-the-counter pain relievers like NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen can help manage mild to moderate pain. For more severe pain, prescription pain medications may be considered, but are typically used short-term due to potential side effects.
- Epidural Steroid Injections: Corticosteroid injections into the epidural space (around the spinal cord) can help reduce inflammation and provide temporary pain relief, particularly for radicular pain.
- Other Injections: Facet joint injections or nerve blocks may be used to target specific pain generators in the spine.
- Lifestyle Modifications: Maintaining a healthy weight, practicing good posture, using ergonomic principles at work and home, and avoiding activities that exacerbate pain are important self-management strategies.
While non-operative treatments cannot reverse the structural changes of spondylosis, they can effectively manage symptoms and allow the body to adapt to these changes, often providing significant and lasting relief without surgery.
Surgical Treatment:
Surgery for spondylosis is typically considered when conservative treatments fail to provide adequate pain relief and functional improvement, and when there is evidence of significant nerve or spinal cord compression. The specific surgical procedure depends on the nature and location of the spinal abnormalities.
Minimally Invasive Surgical Options:
- Bone Spur Removal (Osteophytectomy): Surgical removal of bone spurs that are compressing nerves.
- Spacers: Implantation of interspinous process spacers to create more space between vertebrae and relieve nerve compression.
- Soft Tissue Removal: Removal of thickened ligaments or other soft tissues that are compressing nerves.
More Extensive Surgical Procedures:
- Laminectomy: Surgical removal of a portion of the vertebral bone (lamina) to create more space for the spinal cord and nerves. Lumbar laminectomy is commonly performed for lumbar spondylosis with spinal stenosis.
- Discectomy: Removal of a herniated disc that is compressing a nerve. Anterior cervical discectomy and fusion (ACDF) is a common procedure for cervical spondylosis.
- Spinal Fusion: Joining two or more vertebrae together to stabilize the spine and reduce pain. Fusion may be performed in conjunction with laminectomy or discectomy. Lumbar fusion surgery is used for lumbar spondylosis with instability or severe pain.
Recovery After Spondylosis Surgery: What to Expect
Recovery from spondylosis surgery varies depending on the type of procedure performed. Minimally invasive surgeries generally involve a shorter recovery period compared to more extensive procedures.
Physical therapy is a crucial component of post-operative rehabilitation. It typically begins around six weeks after surgery and focuses on regaining strength, flexibility, and function. Full recovery can take several months, and it’s essential to follow the surgeon’s and physical therapist’s instructions carefully.
Long-term management after spondylosis treatment, whether surgical or non-surgical, includes maintaining a healthy lifestyle, practicing good posture and body mechanics, and addressing any ergonomic factors that may contribute to spinal stress.
Dietary Supplements for Spondylosis: Are They Helpful?
Currently, there is no scientific evidence to support the claim that any specific dietary supplements can effectively treat or prevent spondylosis. While maintaining a healthy diet is always recommended for overall health, there is no specific diet or supplement regimen proven to target spondylosis.
It’s important to exercise caution with dietary supplements, as they are not rigorously regulated by the FDA. Always consult with a healthcare professional before taking any supplements, especially if you have underlying health conditions or are taking medications.
Updated: 4/17/2023
Authors:
Sariah Khormaee, MD, PhD on behalf of HSS Spine
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