Spondylosis, also known as spinal osteoarthritis or degenerative disc disease, refers to age-related wear and tear affecting the spinal vertebrae and discs in the neck and lower back. It often develops gradually over many years and is very common, affecting up to 90% of adults by the age of 50. While spondylosis itself may not cause symptoms, it can lead to chronic pain and disability if compression or instability causes nerve impingement or narrowing of the spinal canal (spinal stenosis). Understanding the types of problems spondylosis can cause helps patients seek appropriate treatment to manage their symptoms and improve quality of life.
What is spondylosis?
Spondylosis occurs due to degeneration of the intervertebral discs, cartilage-filled cushions between the vertebrae that allow flexibility and impact absorption. Over time, these discs lose flexibility and elasticity from everyday stress and strain. As the discs degenerate, the space between vertebrae narrows. Small outgrowths called osteophytes (bone spurs) may also form along the edges of vertebrae for stability but can encroach on nearby nerves and joints. In addition, degenerative changes to facet joints between vertebrae can lead to instability and painful arthritis. While spondylosis develops with age, factors like genetics, lifestyle, and previous back injury may accelerate its progression.
Common symptoms
Many people with spondylosis are asymptomatic. When symptoms do occur, common ones include:
– Chronic lower back pain or neck pain that may radiate into the buttocks or legs. Pain tends to develop gradually over time.
– Stiffness and reduced range of motion in the back or neck.
– Muscle weakness or numbness in the arms, hands, legs or feet. This is caused by nerve compression.
– Tingling or prickling sensations (paresthesia) in the extremities.
– Impaired balance and coordination.
– Headaches at the back of the head due to cervical spondylosis.
Pain is often worse in the morning and improves with movement. Coughing or sneezing can aggravate symptoms by increasing pressure within the spinal canal. In severe cases, spondylosis can eventually contribute to intervertebral disc herniation or spinal stenosis.
Potential complications
Some of the main problems that can arise from spondylosis include:
Spinal stenosis
Narrowing of the spinal canal or neural foramina channels puts pressure on the spinal cord and nerves. This causes neuropathy symptoms like weakness, numbness and tingling in the extremities as well as impaired balance and coordination. It typically develops gradually over years. Most commonly it affects the lumbar region, causing neurogenic claudication where symptoms worsen with walking but improve with sitting or leaning forward. Cervical stenosis can cause myelopathy, a compression of the spinal cord that can lead to loss of dexterity in the hands as well as gait abnormalities if untreated.
Herniated disc
While herniation can occur in healthy discs as well, the degenerate discs in spondylosis have an increased risk. This occurs when the jelly-like nucleus pulposus at the disc center ruptures through a weak spot in the outer annulus fibrosus, putting pressure on nerves. A herniated disc often causes severe sciatica pain, numbness, tingling and muscle weakness.
Spinal instability
Abnormal back motion and alignment due to worn facet joints and disc degeneration. Instability increases the risk of spinal stenosis, herniated discs, osteoarthritis, degenerative spondylolisthesis and chronic pain. Physical therapy can help strengthen core muscles to improve stability. However, spinal fusion surgery may be required in uncontrolled or severe cases to permanently restrict motion.
Foraminal stenosis
Narrowing of the openings between vertebrae where nerves exit the spinal canal. Causes pinched nerve symptoms like radiating pain, numbness and weakness in the area supplied by the compressed nerve. Most common in the cervical spine, affecting the nerves in the upper extremities.
Spondylolisthesis
The spinal vertebra slips out of alignment due to degenerated tissues. Can put pressure on nerves and lead to spinal stenosis. More likely to develop in those with impaired spinal stability.
Neurogenic claudication
Leg pain, weakness numbness induced by walking which improves with rest. It is caused by lumbar spinal stenosis compressing the nerves supplying the lower extremities. Symptoms include aching, cramping and heaviness in the legs.
Myelopathy
Compression damage to the spinal cord from stenosis in the cervical spine. Causes symptoms like gait abnormalities, poor dexterity, numbness, tingling and weakness in the arms and legs. If severe, it can lead to paralysis.
Chronic back or neck pain
Ongoing pain is common, especially in the neck or lower back. Results from compressed nerves, irritated tissues, unstable joints and inflammation. The degree of pain varies but is often worse with activity and improves with rest.
Degenerative spondylolisthesis
The vertebral body slips forward on the bone below due to facet joint instability. Often occurs in the lumbar spine, causing stenosis. Slippage is graded from I to IV based on severity. Lower grade slips may not require surgery while high-grade slips often require fusion.
Sciatica
Radiating leg pain, numbness and tingling caused by compression or irritation of the sciatic nerve roots in the lumbar spine. Usually due to factors like a herniated disc, bone spur or stenosis. Pain typically shoots down the back of the leg to the foot. Moving or coughing can worsen symptoms.
Risk factors
A number of factors can increase one’s risk of developing spondylosis and associated problems:
– Age – Risk rises significantly after age 40 and continues increasing. Up to 95% of people over 65 have some degree of spondylosis.
– Genetics – Inherited traits affecting spinal disc composition and bone shape.
– Past back injury – Prior fractures, strains or disc injuries increase risk.
– Repetitive activities – Jobs or sports with frequent bending and lifting.
– Obesity – Excess weight puts increased stress on the spine.
– Smoking – Associated with faster disc degeneration.
– Bone diseases – Such as osteoporosis which lead to fragile vertebrae.
Diagnosis
If chronic back or neck pain occurs, spondylosis may be suspected. To confirm the diagnosis and pinpoint the cause of symptoms, the doctor will perform:
– Medical history – Ask about symptoms, onset, past injuries, family history, lifestyle factors.
– Physical exam – Check for pain, restricted mobility, altered reflexes, muscle weakness indicating nerve compression.
– X-rays – Assess bone changes and alignment. Can detect narrowed disc space, bone spurs and slipped vertebrae.
– CT or MRI scans – Give detailed images of disc herniations, nerve root compression and stenosis.
– Electromyography (EMG) – Measures electrical activity in muscles to determine if nerves are irritated.
– Nerve conduction study – Monitors how well and fast signals travel through nerves.
These tests help determine the location of nerve compression and guide appropriate treatment approaches.
Non-surgical treatments
For mild to moderate spondylosis without severe instability or neurological deficits, the doctor may recommend trying conservative management first before considering surgery. Options include:
– Medications – Over-the-counter pain relievers, muscle relaxants, antidepressants or anti-inflammatories help relieve discomfort and stiffness.
– Exercise – Light stretches, cardio and core strengthening exercises improve flexibility, posture and support.
– Physical therapy – Stretches, massage, ultrasound heat therapy and TENS units decrease pain. Can also improve strength and mobility.
– Injections – Steroid injectionsreduce inflammation around compressed nerves.
– Lifestyle changes – Smoking cessation, weight loss, modifying activities that worsen symptoms.
– Chiropractic – Spinal manipulation and mobilization help relieve pain in some cases.
– Bracing/orthotics – Reduces load on the spine and restricts painful motion. May help postpone surgery.
– Alternative therapy – Options like acupuncture, yoga, massage therapy may provide symptom relief.
When is surgery necessary?
If conservative treatments fail to adequately improve pain and dysfunction, the doctor may recommend surgery. Indications include:
– Progressive neurological deficits indicating severe nerve compression.
– Unmanageable chronic pain that significantly impacts quality of life.
– Spinal instability causing recurrent pain from motion and microtrauma.
– Severe, high grade spondylolisthesis that continues to worsen over time.
– Herniated discs with intense, radicular pain.
The goals of surgery include decompressing pinched nerves, stabilizing segments of the spine and correcting alignment. Common procedures include:
– Spinal fusion – Permanently joins vertebrae together to eliminate painful motion. Often combined with discectomy for a herniated disc.
– Laminectomy – Removes the lamina bone to relieve pressure on the spinal nerves and cord caused by stenosis or bone spurs.
– Discectomy – Removes herniated disc material pressing on a nerve root. Performed along with fusion.
– Foraminotomy – Widens passages where nerves branch out from the spine to relieve pinching.
– Spinal instrumentation – Implanted rods, screws, plates or cages stabilize and support realigned vertebrae during fusion healing.
Conclusion
While spondylosis itself may not be symptomatic, its effects can lead to chronic back and neck problems if compression, misalignment, instability and arthritis develop in the spine. Seeking timely treatment is important to help manage symptoms and improve outcomes. Conservative measures like physical therapy, anti-inflammatory medications, injections and activity modification can provide relief in many cases. If nonsurgical treatments are ineffective and neurological deficits or severe pain persist, surgical options like fusion or decompression may become necessary to correct the source of the pain and dysfunction. With the right approach, most patients with spondylosis can achieve significant improvement in their comfort and quality of life.