Spondylosis is a generic term that refers to any degeneration (break down) of the bones and/or joints of the spine. The term can be used to describe degeneration in the neck, middle and lower parts of your spine. As with many other terms to describe spinal problems, spondylosis is more of a descriptive term than it is a diagnosis. Literally it can be translated to mean that one has both pain and spine degeneration, regardless of what is causing the pain or where the degeneration is occurring. In fact, spondylosis is sometimes called degenerative disc disease or even spine degeneration.
Some doctors may use the term spondylosis in a general sense, but a spine degeneration doctor will usually use spondylosis along with more specific terms to more accurately describe the disease and to choose degenerative disc disease treatment.
Spondylosis of the spine may refer to osteoarthritis of the spine, which means the areas where vertebral bones come together are inflamed and painful. Spondylosis of the spine may also refer to a problem with the disks that act as cushions between vertebral bones (i.e. intervertebral desks). Reduced range of motion of the neck, the most frequent objective finding on physical examination. MRI and CT scans are helpful for pain diagnosis but generally are not definitive and must be considered together with physical examinations and history. Chronic low back pain is typically the result of spondylosis.
There are three main types of spondylosis of the spine: cervical, thoracic, and lumbar. Cervical spondylosis of the spine affects the first seven vertebral bones, essentially the spinal bones in the neck. Thoracic spondylosis of the spine affects the spinal bones that make up the rib cage, from the base of the neck to the bottom of the ribs. Lumbar spondylosis of the spine affects the spinal bones in the lower back from the bottom of the rib cage down to the pelvis.
Cervical compression is performed by laterally flexing the patient’s head and placing downward pressure on it. A positive sign is neck or shoulder pain on the ipsilateral side, that is, the side to which the head is laterally flexed. This is somewhat predictive of cervical spondylosis along with pain palpation of the spine.
Curiously, most people with spondylosis do not have any specific symptoms. In fact, a doctor may notice spondylosis on an X-ray or CT scan taken for some other purpose. In fact, lumbar spondylosis (spondylosis in the low back) is present in 27%-37% of people without symptoms. In some people, spondylosis causes back and neck pain due to nerve compression (pinched nerves). Nerve compression is caused by bulging discs and bone spurs on the facet joints, causing narrowing of the holes where the nerve roots exit the spinal canal (foraminal stenosis). Even if they are not large enough to directly pinch a nerve, bulging discs can cause local inflammation and cause the nerves in the spine to become more sensitive, increasing pain. Also, disc herniations can push on the ligaments in the spine and cause pain. If new nerves or blood vessels are stimulated to grow from the pressure, chronic pain can result. Because of the pain, the local area of the spine may attempt to splint itself, resulting in regional tenderness, muscle spasm, and trigger points.
Recall that the spinal cord travels down the spinal bones. Nerves in the spinal cord send electrical signals from the brain to various parts of the body, and from various parts of the body to the brain. In some cases, spine degeneration can “pinch” these nerves, limiting their signal transfer. If this occurs, the symptoms of spondylosis can be neurological. Specifically, cervical degenerative disc disease may cause numbness, tingling and/or weakness in the hands and arms and possibly the legs, while thoracic or lumbar degenerative disc disease may cause the same symptoms in the legs.
Characteristic findings of spondylosis can be visualized with X-ray tests. This findings include decrease in the disc space, bony spur formation at the upper or lower portions of the vertebrae, and calcium deposition where the vertebrae have been affected by degenerative inflammation. However, it is controversial if more mild spondylosis, such as small bone spurs and bulging discs that do not compress nerves, cause back pain, because most middle-aged and elderly people have findings on X-ray of spondylosis, even if they are completely pain free. Therefore, other factors are likely major contributors to back pain.
Symptoms of spondylosis include localized pain in the area of spondylosis, usually in the back or neck. If a herniated disc causes a pinched nerve, pain may shoot into a limb. For example, a large disc herniation in the lumbar spine can cause nerve compression and cause pain that originates in the low back and then travels down one leg into the foot. This is called radiculitis.
Back pain due to a bulging disc is typically worse with prolonged standing, sitting, and forward bending and is often better with changing positions frequently and walking. Back pain due to osteoarthritis of the facet joints is typically worse with walking and standing, and relieved with forward bending. Symptoms of numbness and tingling may be felt if a nerve is pinched. If a nerve is severely pinched, weakness of an affected extremity may occur. If a herniated disc pushes on the spinal cord, this can cause injury to the spinal cord (myelopathy). Symptoms of myelopathy include numbness, tingling, and weakness. For example, a large herniated disc in the cervical spine could cause cervical myelopathy if it is large enough to push on the spinal cord with resulting symptoms of numbness, tingling, and weakness in the arms and possibly the legs.
A person with severe spondylosis may lose coordination and have difficulty walking, or they may lose control of their bladder or bowels. If any of these symptoms occurs, it is a medical emergency, and the affected person should seek immediate emergency medical attention.
No medication has been proven to reverse the degenerative process of spondylosis. Treatment of pain from spondylosis commonly includes anti-inflammatory medications, analgesics (pain medications), and muscle relaxants. Nonsteroidal anti-inflammatory medications, or NSAIDs, can be very effective in relieving back and neck pain from spondylosis.
Some of these medications, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), are available without a prescription. Other NSAIDs are prescription strength and may be prescribed by your health-care professional. Muscle relaxants such as cyclobenzaprine (Flexeril) and tizanidine (Zanaflex) are examples of prescription medications that can relieve the muscle spasm associated with spondylosis.
Analgesics (pain medications), such as acetaminophen (Tylenol) and tramadol(Ultram), are used to treat pain. If the pain is extremely severe, sometimes a narcotic medication (Norco, Vicodin or others) is prescribed for the first several days. Fish oil is known to be anti-inflammatory and has been proven to improve several conditions such as heart disease and rheumatoid arthritis. There are some studies suggesting it may improve back and neck pain symptoms as well.
Certain antidepressants are helpful in treating chronic back pain. Medications termed tricyclic antidepressants, including amitriptyline (Elavil) and doxepin(Sinequan), have been used for many years, in low doses, to treat chronic back pain, neck pain, and other pain.
Recently, another antidepressant,duloxetine (Cymbalta), has been shown to improve chronic back pain. Cymbalta is approved by the Food and Drug Administration (FDA approved) to treat chronic low back pain as well as other chronic pain conditions.
Some people find topical medications, which are massaged directly onto the location of the pain, helpful in relieving pain from spondylosis. These medications work in different ways, and many are available without a prescription. Some examples of topical medications include Aspercreme, which contains aspirin, and is anti-inflammatory. Capsaicin cream is another topical medication which many find helpful. Capsaicin is the active ingredient in chili pepper and should not be used on areas where the skin is cut or irritated. After application, thorough hand washing is important, especially prior to touching the face, to avoid irritation from the capsaicin.
When pain persists despite conservative care, interventional and minimally invasive spine surgery may be appropriate for you. Consult with a spine specialist at Regional Orthopedics for further evaluation.
Surgical degenerative disc disease treatment depends on the specific cause, location, and severity of the spondylosis. In some cases, the spine degeneration doctor (usually an orthopedic spine surgeon) may remove one or more damaged intervertebral discs. The spine surgeon may also remove a small section of a spinal bone to help the passage of neurological signals from the spinal cord to the body. In yet other cases of spondylosis, the spine degeneration doctor may choose one or more spinal bones together in a procedure called spinal fusion surgery. Lastly, damaged discs may be replaced with an artificial disc made out of plastic and metal.
If you think you may be experiencing spondylosis or have been told you have spondylosis, it is important to speak with a local spine degeneration doctor in New York City or surrounding areas. Contact the experts at Regional Orthopedics for an evaluation and consultation.