What is Spondylosis?
Spondylosis describes the degeneration and “wearing out” of the spine that normally occurs with aging. It occurs in everyone with time (unfortunately just like gray hair and wrinkles!) and is present in 100% of the population over the age of 70. The aging and degenerative process results forms in the formation of bony projections (spurs) and reduces the height of the spongy discs between the vertebrae.
Spondylosis is often also called spinal osteoarthritis. It can affect the neck (cervical spine), upper, mid and lower back (thoracic spine and lumbar spine). The most common area affected is that of the lumbar spine and cervical spine.
What Causes Spondylosis?
The causes of spondylosis are:
- Age, which leads to wear and tear of the discs and spinal facet joints
- Genetic predisposition
Most people with spondylosis are asymptomatic and have no pain or any problems at all as spondylosis is part of the normal aging process. Some people have significant back pain associated with spondylosis but many do not, and currently it is still unclear why that is the case. We do know that patients that being overweight, being inactive without getting daily exercise, and smoking all increase the risk of back pain with spondylosis. When spondylosis is symptomatic, the signs and symptoms include:
- Back and neck pain
- Numbness and tingling of arms and legs if nerve compression also exists
- Muscle spasms
- Sciatica (low back pain extending down the leg)
- Scoliosis or kyphosis
How is Spondylosis Diagnosed?
Your doctor will diagnose spondylosis after reviewing your medical history and performing a physical examination. Additional diagnostic tests for spondylosis may be ordered depending on precisely what symptoms are present, such as:
- Magnetic resonance imaging (MRI)
- Computerized tomography (CT) scans
- Electromyogram and nerve conduction studies to measure electrical activity of the nerves
Treatment of spondylosis depends on the type and severity of symptoms. Conservative treatment is always recommended first and may include :
- Medications: These include non-steroidal anti-inflammatory medications (NSAIDS), acetaminophen, oral steroids, and muscle relaxers. Opioid or narcotic medication should be avoided as they do not help and may worsen the problem as they can cause addiction and tolerance.
- Self-care: You can use heat and/or ice therapy to lessen the pain. You can experiment with different types of pillows or mattresses to help with neck pain. Everyone is different as to which type of pillow or mattress is best to help with symptoms.
- Exercises: Your physical therapist will teach you exercises to strengthen your back and stomach (core) muscles. Regular walking, yoga, stationary bike, or other forms of low-impact regular aerobic exercise are critical in helping to relieve chronic back and neck pain by increasing the blood flow to the degenerated and weak spinal discs, ligaments, and other soft tissues.
- Adjunctive therapies: Acupuncture, which involves the insertion of very thin needles into the body, may be beneficial for back pain. Dry needling performed by physical therapists can also be helpful. Chiropractic spinal manipulations of the lower or mid back may also be helpful. Neck manipulation is NOT recommended as there are rare risks of catastrophic spinal cord injury or artery dissection in the neck that could result in quadriplegia, stroke, or even death with vigorous neck manipulation.
- Injections: More invasive treatments performed by a physiatrist or an anesthesiologist trained in pain management may also be helpful. These can include epidural injections, facet injections, or radiofrequency ablations.
Surgical Treatment of Spondylosis
Spine surgery unfortunately is not a reliable treatment for patients with primarily neck or back pain symptoms from spondylosis. This is because chronic neck and back pain is multifactorial and experience has shown that patients do not reliably have relief of their neck or back pain after surgery. However, if arm pain or leg pain is the primary complaint due to nerve compression and conservative treatments have failed, surgery can be very successful at relieving the nerve compression and improving arm or leg pain. Surgery can also be helpful in certain situations when spondylosis is causing a spinal deformity such as scoliosis or kyphosis. The specific operation that is recommended depends on many factors and is individualized to the patient’s specific goals and needs.