Spondylosis

Spondylosis is a degenerative disorder of the spine due to the ageing process which disrupts the normal structure and function of the spine. It affects all the different structural components of the spine including intervertebral discs, ligaments, bones and facet joints. It is also called osteoarthritis of the spine or degenerative joint disease (DJD). Depending on the level of the spine affected, it is classified as:

  • Cervical spondylosis: Affects spine of the neck region
  • Thoracic spondylosis: Affects spine of the mid back region
  • Lumbar spondylosis: Affects spine of the low back region
  • Sacral spondylosis: Affects spine of the lower back region

Causes

With advancing age, the degenerative process increases leading to thinning of the intervertebral discs due to loss of water from the discs. This results in a reduction in the disc height with a decreased ability to absorb shock. These degenerative changes exert extra pressure on the facet joints with an increased wearing of the joint cartilage resulting in the formation of bone spurs or osteophytes. Osteophytes may also develop close to the vertebral end plate. Degenerative changes also cause thickening of the spinal ligaments resulting in a loss of strength and compression of the adjacent spinal nerve or spinal cord.  Trauma, injury, poor posture, overweight and repetitive movement of the spine may aggravate the condition.

Symptoms

 The symptoms of spondylosis vary depending on the area of the spine affected. They may include stiffness and back pain (especially in the morning); numbness, burning or tingling sensations; sciatica and cervical radiculopathy; weakness in the legs and arms; muscle spasms; improper gait or limping. In rare cases, it may also lead to bowel or bladder dysfunction.

Diagnosis

Diagnosis of spondylosis includes medical history, physical and neurological examination. Physical examination includes evaluation of range of motion and spinal stability. Neurological examination is done to detect any signs of neurological injury and involves evaluation of reflexes and muscle weakness. To confirm the diagnosis the doctor may also advise imaging tests such as X-ray, MRI or CT scan. Usually X-rays are recommended and may be taken from the side, front or back in different positions. MRI may also be ordered to assess nerve compression.

Treatment

Non-surgical treatment

Surgery is rarely required for spondylosis. Non-surgical treatment is usually preferred over surgery. The non-surgical options include rest, activity modification, pain medication, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, physical therapy and spinal injections. Braces may be recommended to keep the back or neck still and reduce mechanical pain. Acupuncture may be helpful in some cases.

Surgery

Spondylosis is a progressive disorder. Surgery is considered only in patients with severe pain that does not improve with non-surgical treatment or in patients with spinal instability. Emergency surgery may be required in cases of neurologic dysfunction or cauda equine syndrome. Surgery is aimed at reducing the nerve compression and stabilizing the spine and involves spinal instrumentation and fusion.

If you have been recommended a surgery, consult your surgeon to clarify any concerns you have about the surgery.



HARVARD MEDICAL SCHOOL ASHPP PENN SIS AMA NASS aaPM&R ISASS - The International Society for the Advancement of Spine Surgery