Spondylosis

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Overview

Literally, spondylosis is defined as being the hardening or setting of spinal bone blocks, as a result of degenerative changes in the spine.

Spondylosis is the appearance of specific bone spurs and intervertebral disc degeneration. All changes characteristic for spondylosis in the spine, are frequently referred to as osteoarthritis. Lumbar spine spondylosis refers to degenerative changes such as osteoarthritis and intervertebral disc degeneration in the lower back.

Spondylosis can be located both in the upper or cervical spine, but it can affect the lumbar spine too.

Lumbar and cervical spondylosis are the most common. Thoracic spondylosis do not cause symptoms. Lumbosacral spondylosis spondylosis is affecting both lumbar spine and sacral spine.

There are many medical terms that sound similar to spondylosis and are often mistaken for it, including:

- Ankylosing – inflamed one or more vertebrae, such as ankylosing spondylitis, an inflammatory arthritis of the spine. This is different from spondylosis, considering that spondylosis is degenerative because while spondylitis is inflammatory.
- Spondylolysis – cracking or fracture of a vertebra and the upper portion or upper arch, is a ossification defect predisposing to spondylolisthesis, due to spinal instability.
- Spondylolisthesis – the forward or backward movement of the body of a lumbar vertebrae, on the sacrum. As such, the spine is not aligned normally.
- Deforming spondylosis – involves the growth of osteophytes or bone spurs around the intravertebral disc degeneration of the spine.
- Spinal stenosis – narrowing of the spinal canal. This narrowing of the spinal canal space required limit spinal cord and nerves. This put some pressure on the spinal cord and nerves due to narrow space, causing pain, numbness and tingling.


Contents

1. Overview
2. Spondylosis – causes and risk factors
3. Signs and symptoms of spondylosis
4. When to seek medical
5. Diagnosis
6. Treatment
7. Surgery
8. Complications of the spine


Spondylosis – causes and risk factors

Spondylosis is a specific phenomenon of aging. With aging, bones and ligaments of the spine wear out and form bone spurs (osteoarthritis). Intervertebral discs degenerate and weaken, which can lead to disc herniation and disc swelling. Spondylosis is common. Symptoms of the condition are often reported between ages 20-50 years.


Signs and symptoms of spondylosis

Many of the patients diagnosed by X-ray radiographs, with spondylosis, have no symptoms. In fact, lumbar spondylosis is present in 27-37% of those without symptoms. Still, for some of the people, spondylosis causes back pain and neck pain due to nerve compression (squeeze or pinch nerves).

Nerve compression is caused by bulging discs and bone spurs in the joint surface, the narrowing cavities in which nerves leave the spinal canal. Although bony spurs are not large enough to press or pinch a nerve directly, swelling discs can trigger local inflammation and nerve sensitization of the spine.

Disc herniation can push existing ligaments in the spine and cause pain. When new blood vessels or nerves are stimulated to grow in size due to pressure, chronic pain can result. Locally the pain, tenderness and muscle spasms might occur.

Symptoms of spondylosis are located in the affected area, usually the back or neck. If a herniated disc pinches a nerve, pain can occur daily.

A worsen disc herniation, at the lumbar spine level, can cause nerve compression and pain, and that can travel down to the leg. Back pain caused by bulging discs get worse when the patient sits for hours standing or sitting, when leaning forward and getting better while walking or when painful position is changed.

Back pain due to facet joint osteoarthritis is worse when walking and when the patient sits upright and is relieved when he leans forward.

Symptoms of numbness and tingling may be felt if a nerve is blocked. When a nerve is severely injured extremity weakness occur. If the herniated disk presses spinal cord may occur myelopathy characterized by this numbness, tingling and weakness.

For example, if a herniated disc is quite serious and is located in the cervical spine, it may cause cervical myelopathy and may exhibit numbness, tingling, weakness in the arms and possibly legs.


When to seek medical

The diagnosis of spondylosis will be established after X-ray radiography, CT scan or MRI. Revaluation medical reasons may include the following situations:

- the pain is not managed by prescribed treatment
- for development of acute nerve dysfunction such as weakness in one or more extremities
- loss of bladder or bowel control, acute back or neck pain, inability to trigger or stop urination
- numbness in the groin or numbness felt in the form of his pelvis. This could indicate a serious nerve disorder and should be evaluated medical emergency.
- if back pain or neck are associated with weight loss or fever higher than 38.5C


Diagnosis

The diagnosis of spondylosis will be set using X-ray radiography, MRI or CT. X-rays that can indicate bone spurs in the spinal cord, thickening of joint faces and narrowing intervertebral disc spaces.

After CT of the spine, it will be displayed in detail and will diagnose the narrowing of spinal canal.

MRI is an expensive investigation, but shows in detail the spine and is used to view intervertebral discs, including disc hernia if present. An MRI can be used to view the vertebrae, sides of joints, nerves, ligaments of the spine and can determine if a nerve is pinched.


Treatment

There is no treatment to reverse spondylosis, because it is a degenerative process. Target will focus on back and neck’s pain annihilation, being similar for these types of pain relief. There are several types of treatment available: medicines, self-care, exercise, physical therapy and adjuvant therapies, minimally invasive procedures and surgery.

Self-care measures at home for spondylosis

Self-care at home is important, because it can relieve pain or treat after a few days. Experts have found that prolonged bed rest during recovery. It is therefore recommended to continue normal or near normal activities. However, there will be no action that could exacerbate the problem, such as lifting weights. Some people have found that local application of ice or heat may be helpful for back and neck pain due to spondylosis.

Sleeping at night with a pillow between your legs may be helpful for those suffering from pain localized in the lower back.

Physical therapy, exercise and adjunctive therapy for spondylosis

Your doctor may prescribe physiotherapy for back or neck pain that do not pass by itself after a few weeks. Physical therapy is often prescribed for chronic back pain or neck muscle pain, for toning and strengthening fitness. Therapists will recommend specific exercises for each patient, which will be made every day, helping by strengthening back muscles, the abdominal and preventing the pain recurring. Exercise done regularly, especially walking and yoga, have been scientifically proven to be beneficial for chronic back pain.

- Chiropractic manipulation of the spine can be helpful for some people, especially in the first month when pain begins. However, some patients should avoid this kind of handling for safety reasons, considering that patients with inflammatory arthritis which was damaged the spine too and, in some cases rheumatoid arthritis.
- Acupuncture for back pain involves placing very thin needles to various depths in specific areas of the body. Introduction is designed to balance the chi meridians flowing throughout the body.

Injections and minimally invasive procedures for spondylosis

- Epidural injection refers to injection of steroids (cortisone) into the epidural space. Steroids can be injected into the facet joints connecting the vertebrae and intervertebral spaces. These procedures may have a role in acute pain management, especially radicular pain radiating daily.

Other procedures include back and neck, injecting various medicinal preparations (injections of cortisone injected into intra-vertebral disc), steroid injections, anesthesia, or both areas triggering pain, sacroiliac joint injections, steroid injections into the muscles piriformis in piriformis syndrome and radiofrequency denervation (painful nerve damage with a radiofrequency current).


Surgery

Surgery in patients with chronic back pain is controversial because, although some studies have shown that surgery can relieve pain and reduce the chances of a person to suffer disabilities, others have shown that there is no improvement compared with nonsurgical treatment, such as physical therapy and pain management.

Many people continue to have chronic back pain after surgery. Surgery is rarely necessary for patients with acute back pain, except that develop degenerative neurological problems. Most of the people suffering from spondylosis found that symptoms improved significantly after drug treatment and physiotherapy within a few days to several weeks after the onset of back pain.

Surgery is sometimes performed in cases of acute sciatic, when the nerve problems such as weakness and numbness that worsens and, in cauda equina syndrome’s case.

Decompression surgery of the spine is a general term used to describe various surgical procedures that are performed to alleviate pressure on spinal nerves due to spinal stenosis, herniated spinal discs or foraminal stenosis. The decompression techniques commonly used include:

- laminectomy – a procedure to remove portions of the channel molding bone to enlarge the size of the spinal canal and relieve pressure on the spinal cord.
- discectomy – is the procedure to remove part of an intra-vertebral disc that puts pressure on the nerve or the spinal canal
- foraminotomy or foraminectomy – is the procedure to enlarge the openings for nerve roots as they can leave the spinal canal. During foraminectomy is removed more tissue than during foraminotomy
- removing bone spurs – is the procedure to remove bone spurs from an area where they pinch nerves
- corpectomy – is the procedure for removal of a vertebral body and vertebral discs
- spinal fusion – is sometimes combined with one or more procedures to stabilize the spine.


Complications of the spine

The main complications are pain sacral spine, back or neck. Back or neck pain caused by spondylosis isn’t sharp, but some people may experience chronic pain. It is unusual for spondylosis to meet severe neurological dysfunction due to nerve compression.

Over time, degenerative changes of spondylosis can cause spinal stenosis, where the spinal canal narrows and the pressure on the cervical spine is emphasized. Therefore, neck or spinal stenosis may be a cervical spondylosis complication.

When it comes about cauda equina syndrome, nerves in the lower spine are compressed by an intra-vertebral disc or a mass. This is a rare complication of spondylosis, which can cause serious nerve problems.

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