Spondylosis and Degeneration

Spondylosis is the term given to arthritic and degenerative changes in the spine. This condition really represents wear and tear on the elements of the spine. It includes damage to both the discs and the joints. The term spondylosis includes Degenerative Disc Disease and Degenerative Joint Disease of the spine. So, don’t get confused if your doctor diagnoses you with one of these conditions.

You may hear terms like arthritis (inflammation of the joints), or arthrosis (degeneration of the joints). Degeneration indicates damage to the joints beyond simple arthritis. It includes things like loss of joint space, bone spurs, thickening of the joints, or deformity of the joints. Degeneration of the discs indicates a loss of disc space and drying or desiccation of the discs. This usually occurs after disc damage resulting in disc tears, herniations, or bulges. Findings of degenerative changes can only be demonstrated with imaging (X-ray, MRI, CT, etc.).

Causes

Spondylosis is caused by wear and tear over the years (which is why it is more common in the elderly). the condition is accelerated by poor spinal mechanics. This can occur after injury to the spine, poor posture, bad habits, or deconditioning. It can also be due to other underlying conditions such as rheumatoid arthritis, psoriatic arthritis, and other autoimmune disease. Some disease processes can cause calcification of the ligaments that drive degenerative changes such as D.I.S.H and ankylosing spondylitis.

Signs & Symptoms

Spondylosis typically presents with advanced age and sometimes in younger populations after acute or repetitive trauma. Pain is typically deep and dull and accompanied by restricted movement in the spine. Most patients will feel more stiffness and pain after long periods of being static. For example, after first awaking in the morning. Imaging reveals degenerative changes including: decreased joint space, thickening of the bones, calcium deposits in the surrounding soft tissues, and bone spurs. A severe case would likely be described as “bone on bone” arthritis. Pain at the end ranges of movement is typically more sharp and local to the spine. Radiating pain can also occur into the arms, hands, legs, or feet if nerves are compromised. These neurological symptoms are related to stenosis: the pinching of nerves within the spine.

Treatment of Spondylosis

Treatment for spondylosis involves motion. As the spine loses height and degenerates, the movement at the joint becomes restricted and the lack of motion results in poor blood flow and inability to heal. Because the joints and discs have such poor blood supply, it is the movement that helps to pump fluid in and out of the area. This fluid brings in nutrients to repair and removes waist products. Without this movement, the joint will eventually completely seize up and fuse.

Manipulation, Range of Motion exercises, and passive stretching are the foundations for improving joint motion. Soft tissue therapies like massage and scraping can help the mobility of the outer tissues, but movement in the joints is the ultimate goal. Other passive therapies that relieve pain can be useful but will not treat the root of the problem. Even medications like aspirin or other NSAIDs will only help to diminish pain and inflammation temporarily. Medications will not correct the underlying mechanical problem in the joints. In fact, long term studies show that patients who use anti-inflammatories such as NSAIDs or Steroids actually have worse outcomes years in the future due to these medicines effect on healing.

More advanced cases may require surgery. Sometimes the joints can be cleaned up. Bone spurs can be surgically removed creating more space and better movement. Disc material can also be removed to accomplish the same. This is the more conservative surgery called a partially laminectomy or partial discectomy respectively. Other times the joint is too far gone and the solution is simply to allow the joint to fuse naturally or fuse surgically by addition of hardware. Surgical fusions that add hardware typically do not result in good outcomes. It is my opinion that they should be a last resort.

Prognosis of Spondylosis

The likelihood of resolution depends entirely on how far the spondylosis has progressed. Many times, once the degenerative changes are identified on imaging, there is too much damage to have full resolution. However, improvement of pain and function is likely achievable. The best outcomes are when spinal mechanics are corrected early stopping the degenerative process in it’s tracks. The poorest outcomes are associated with spinal surgeries where hardware is added due to the advanced nature of the condition.