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Spondylosis is a degenerative disorder that may cause loss of spinal structure or functioning. Typically, there is stiffening or fixation of a vertebral joint as the result of disease, with a fibrous or bony union developing across the joint. Vertebral means referring to vertebrae, which are bones that form an opening in which the spinal cord passes. A joint is a place where two bones contact each other. The vertebral bones are stacked one on top of another as shown in the second picture below. Each individual bone that makes up the vertebrae is called a vertebra. The main part of this bone is called the vertebral body. In between the vertebrae are flat, cushiony disks (known as intervertebral disks) that act as shock absorbers. These disks are represented by the red areas.
ARE THERE DIFFERENT TYPES OF SPONDYLOSIS?
The location and severity of spondylosis varies from person to person. There are three main types of spondylosis, with the first two being the most common:
CERVICAL SPONDYLOSIS: This is any process in which the cervical spine (the part of the spine by the neck) degenerates and produces narrowing of the spinal canal. The spinal canal is the space between the spinal cord and the bony structure that surrounds it. Narrowing of the spinal canal can compress the spinal cord and spinal nerves. The structure of the cervical spine is very complex. Since it has a wide range of motion, the cervical spine is prone to disorders associated with degenerative changes.
LUMBAR SPONDYLOSIS: This is when there is any narrowing of the spinal canal in the lower back (lumbar) region. Spondylosis affects the lumbar spine in people over age 40. Pain and morning stiffness are common complaints when this spinal region has been affected. Usually, more than one vertebra is involved. Because the lumbar spine carries most of a person's weight, pain may accompany physical activity when degenerative forces weaken the structure of this area. This is especially likely during repetitive movements such as lifting. Sitting for prolonged periods of time can cause pain and other symptoms due to pressure on the lumbar vertebrae.
THORACIC SPONDYLOSIS: This is when there is any narrowing of the spinal canal behind the thoracic region (the area behind the upper to middle part of the chest). The pain associated with this condition is typically caused by flexing or hyperextending the back.
WHAT ARE SIGNS AND SYMPTOMS OF SPONDYLOSIS?
In mild cases of spondylosis, there may not be any signs or symptoms. However, when signs and symptoms occur, pain and stiffness in the neck and lower back are common. Neck pain and neck stiffness are especially likely in the morning or after performing recreational activities. Headaches can occur, especially in the back of the head. Other symptoms include pain, weakness, and/or loss of sensation in the arms, fingers, shoulders, and legs. Some people experience a sensation of pain spreading down from the arms. Additional symptoms include movement difficulty, imbalance, buzzing in the ears, loss of bladder control due to pressure on the spinal cord, inability to retain feces (poop), difficulty swallowing, and muscle spasms (involuntary movements) around the spine. In the most severe cases, severe impairment and paralysis (loss of movement and/or sensation) can occur.
WHAT CAUSES SPONDYLOSIS?
Spondylosis is mainly caused by aging. As people age, certain biological and chemical changes cause tissues throughout the body to degenerate. In the spine, the vertebrae (spinal bones) and intervertebral disks degenerate with aging. As was mentioned earlier, the intervertebral disks are cushion like structures that act as shock absorbers between the vertebral bones.
One of the structures that form the disks is known as the annulus fibrosus. The annulus fibrosus is made up of the 60 or more tough circular bands of collagen fiber (called lamellae). Collage is a type of inelastic fiber. Collagen fibers, along with water and proteoglycans (types of large molecules made of a protein and at least one carbohydrate chain) help to form the soft, gel-like center part of each disk. This soft, center part is known as the nucleus pulposus and is surrounded by the annulus fibrosus. The nucleus pulposus is shown in the drawing below:
The degenerative effects of aging can cause the fibers of the disks to weaken, causing wear and tear. Constant wear and tear and injury to the joints of the vertebrae causes inflammation in the joints. Degeneration of the disks leads to the formation of mineral deposits within the disks. The water content of the center of the disk decreases with age and as a result the disks become hard, stiff, and decreased in size. This, in turn, results in strain on all the surrounding joints and tissues, causing the sensation of stiffness. With less water in the center of the disks, they have decreased shock absorbing qualities. An increased risk of disk herniation also results, which is when the disk abnormally protrudes from its normal position.
Each vertebral body contains four joints that act as hinges. These hinges are known as facet joints or zygapophyseal joints. The job of the facet joins is to allow the spinal column to flex, extend, and rotate. The bones of the facet joints are covered with cartilage (a type of flexible tissue) known as end plates. The job of the end plates is to attach the disks to the vertebrae and to supply nutrients to the disk. When the facet joints degenerate, the size of the end plates can decrease and stiffen. Movement can stimulate pain fibers in the facet joints and annulus fibrosus (see above). Furthermore, the vertebral bone underneath the end plates can become thick and hard.
Degenerative disease can cause ligaments to lose their strength. A ligament is a tough band of tissue that attaches to joint bones. In the spine, ligaments connect spinal structures such as vertebrae and prevent them from moving too much. In spondylosis, one of the main ligaments (known as the ligamentum flavum) can thicken or buckle, making it weaken.
Knobby, abnormal bone growths (known as bone spurs or osteophytes) can form in the vertebrae. These changes can also cause osteoarthritis. Osteoarthritis is a disease of the joints that is made worse by stress. In more severe cases, these bones spurs can compress nerves coming out of the spinal cord and/or decreased blood supply to the vertebrae. Areas of the body supplied by these nerves may become painful or develop loss of sensation and function. This explains why some people have neck pain or arm pain. For example, when a bone spur compresses a nerve in the neck, arm weakness can result. Poor coordination results because it is difficult to control muscles with poor sensations. Rarely, bone spurs in the front of the cervical spine can cause difficulty swallowing. Since the neck is the gateway to many nerves that lead to various parts of the body, when the neck is affected by spondylosis, impaired functioning in those different body parts can result. A picture of degenerative disks with osteophyte formation is shown to the right.
ARE THERE RISK FACTORS FOR SPONDYLOSIS?
Yes. The main risk factor for spondylosis is age.
HOW IS SPONDYLOSIS DIAGNOSED?
The first step towards diagnosis of spondylosis is a thorough review of the patient's personal and family medical history and a detailed physical evaluation. A physical evaluation can tell a lot about the health and general fitness of the patient. A physical exam can be done through a neurological examination. A neurological examination formally assesses the patient's sensory symptoms such as pain, numbness, and abnormal sensations (such as tingling). It can also assess motor (movement) functioning, especially in the arms and legs. The degree that the patient can flex, extend, bend to the side, and rotate different body pats are used to assess motor functioning. Examination by touch helps determine spinal abnormalities such as tenderness and muscle spasms. Reasons for bowel and bladder changes can also be examined through the physical exam. If the neurological examination shows abnormalities, additional tests may be needed to understand the nature and extent of disease.
One of the most common tests used to diagnosis spondyolsis is an x-ray to examine the condition of the neck bones. An x-ray can tell if there has been a decrease in disk size and if bone spurs are present. Sometimes, a discography is used in which colored dye is actually injected into the disk so that the disk shows up more clearly on the x-ray. A discography is useful because it can help identify the exact source of pain. A similar test is called the facet joint block test, in which medicine is injected to numb a joint. If the injection helps to reduce pain, the doctor assumes he/she has found where the pain is coming from. Yet another common test is known as a myelogram, which highlights the condition of the spinal cord and nerves by injecting a special dye into the spine.
More advanced and sensitive techniques are used in more serious cases. Two of these tests are known as CT (computerized tomography) scanning and MRI (Magnetic Resonance Imaging). CT scanning is an advanced imaging technique that uses x-rays and computer technology to produce more clear and detailed pictures than a traditional x-ray. MRI scans produce extremely detailed pictures of the inside of the body by using very powerful magnets and computer technology. MRI is better than CT scans at evaluating soft tissue, ligament, disk, and nerve abnormalities. CT scans are better than MRI at evaluating bones (such as the bony changes associated with spondylosis). Lastly, electromyography (EMG) is sometimes used to help diagnose spondylosis because it measures electrical impulses to assess the health and strength of muscles and the nerves that control muscles.
Once the tests are completed, the doctor compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. Also, the test results will provide a baseline from which the doctor can monitor the patient's progress.
HOW IS SPONDYLOSIS TREATED?
To begin with, the doctor may suggest rest because in mild cases the symptoms sometimes go away without medical treatment. However, a balance between rest and mild to moderate physical activity is often recommended, except in some severe cases. Regular, gentle exercise can help ease neck pain and stiffness. Physical therapists are often consulted to develop the best exercise routine. Physical therapy is sometimes attempted to strengthen and rehabilitate the muscles and joints by the spine and belly. Strengthening muscles near the belly helps provide support to the spine. Physical therapists can also use electrical stimulation and heat to reduce symptoms such and pain and muscle spasms.
Sometimes, isometric exercises are used when movement is painful or difficult. Isometric exercise involves tensing a muscle and holding it in a stationary position while maintaining the tension. Isometric exercises are especially helpful to people recovering from injuries that limit movements. In general, exercise helps increase strength, flexibility, and range of movement.
Swimming or hydrotherapy can help overcome stiffness. Hydrotherapy is the use of water to treat disease. If such an approach is taken, it is more likely for the discomfort to improve with time, but the stiffness may remain. Lifestyle changes may also be needed such as quitting smoking, losing weight, and changing jobs (such as avoiding manual labor). Strong medical reassurance by the doctor and recommendations on how to improve posture and physical fitness can also be helpful.
In serious cases, the doctor may ask the patient to wear a neck collar or neck brace so that the neck becomes stabilized and rested to reduce pain. To stabilize and prevent stress on the lower back, a lumbar (lower back) support belt may be suggested. During the sudden onset of symptoms, medications may be prescribed for a short period of time to relieve pain, help muscles relax, and reduce inflammation.
In the most serious cases, traction and/or surgery may be necessary. Traction is a treatment that uses a pulling force to keep a joint in place, prevent or decrease muscle spasms, or to hold the end of broken bones in place. In spondylosis, traction helps to reduce pressure by attaching a device to the patient's head and pulling up on it by using a system of pulleys and weights. The traction device is usually applied a few times a day and can be used while sitting or lying in bed. In some severe cases, bed rest for one or two weeks might be necessary.
It should be mentioned that surgery is seldomly used to treat spondylosis and that it is only used as a last option. Whether surgery can be used in severe cases depends on the patient's age, lifestyle, occupation, how long the condition has been present, the degree and nature of the damage, and if motor or sensory symptoms are present. Surgery involves removing the abnormal bony growths and/or stabilizing the neck by fusing the vertebrae together (known as spinal fusion). A spinal doctor is needed to determine if surgery is necessary.
WHAT IS THE PROGNOSIS FOR PEOPLE WITH SPONDYLOSIS?
The answer to this depends on the severity of the case. As was mentioned in the last section, mild cases may go away without treatment. In fact, about 75% of cases go away without having to resort to surgery. If medication is required, chances of recovery improve by taking medications as directed and reporting side effects to physicians. Prognosis generally improves by following the prescribed physical therapy program, stopping smoking, keeping an average weight, and avoiding heavy lifting or other situations that increase pain or other symptoms.
In severe cases, long-lasting and permanent disability may result. Neck pain, for example, can be long-standing and there can be worsening loss of muscle function and sensation over time. Long-lasting disability is rare, however. The doctor and/or physical therapist will be able to provide strategies to reduce the risk of further back problems and whether or not any restrictions in work and/or recreational activities should be present.
WHAT ELSE IS SPONDYLOSIS KNOWN AS?
Spondylosis is also known as spinal osteoarthritis.
WHAT IS THE ORIGIN OF THE TERM, SPONDYLOSIS?
Spondylosis comes from the Greek word "spondylos" meaning "vertebra" and the Greek word "osis" meaning "condition." Put the words together and you have "vertebra condition."