Spondylosis – Diagnosis and Treatment
Spondylosis is a degenerative condition of the spine that is generally related to ageing. Literally it means disc degeneration and it can affect various regions of the body, particularly the neck (cervical spondylosis), middle back (thoracic spondylosis), and lower back (lumbar spondylosis). The condition is also called spinal osteoarthritis.
What it affects
The condition can impair the normal structure and function of the spine, and different parts of the spine are affected. These include:
- Intervertebral discs– the degenerative effects of ageing can affect the structure of the discs and degrade their ability to cushion and absorb shock. The discs thin and become prone to rupture.
- Facet Joints – these are the joints of the spine that connect the vertebrae and allow the spine to extend, flex, and rotate. The facet joint has two bony surfaces which have a cartilage layer between them and surrounding fluid producing capsule. The fluid lubricates the cartilage and bone interface allowing the joint to move without friction. However, the cartilage can degenerate increasing friction and bone spurs can form resulting in osteoarthritis.
- Bones and ligaments – bone spurs can reduce blood supply to the vertebrae and ligaments can weaken and buckle. Sclerosis can also cause the end plates to stiffen.
You may have spondylosis without showing any symptoms; for instance, around a third of people with lumbar spondylosis are asymptomatic. However, you are likely to experience pain in the locally damaged areas.
Often pain begins following an injury followed by sudden unexpected pain; a small injury or just a movement which is followed by back pain; or it starts as a small pain which becomes progressively worse. As there are several different areas where spondylosis can occur, different kinds of pain are felt. The most common forms of the condition are:
Neck pain is the most common symptom which often spreads down into the shoulders and the arms. Sometimes a bone spur can compress a nerve which can result in weakness of the arm. It can also make it difficult to swallow.
This causes middle back pain especially when you bend forward or overextending your back. The first is caused by your spine discs while the second is due to facets.
This tends to affect people aged over 40. It is what can cause you to have a stiff and painful back when you get out of bed. Often several lumbar vertebrae are affected; as these carry most of the body’s weight the pain often occurs following any activity. Pressure associated with sitting for a long time can also cause lumbar pain, as can lifting and bending.
Spondylosis isn’t a condition that has a single diagnosis; the term is used to describe a range of conditions as we have already indicated. It simply means a combination of back pain and associated degeneration of the spine.
The first stage of the diagnosis will be to discover exactly what is causing your back pain. It may or may not be spondylosis, or you might have spondylosis yet your back pain might be caused by something entirely different.
The first stage will be to carry out a physical examination. You might be asked to bend, to rotate your head and carry out other movements while the specialist examines you. Your reflexes will also be tested along with checks that you have full sensations in your legs and arms.
It is likely that you will also receive an X-ray and possibly an MRI or a CT scan. You might also have a nerve conduction test to check how well your nerves are working.
As spondylosis is a degenerative condition, there currently isn’t a treatment that is able to reverse the process. Thus available treatments focus on managing rather than curing the condition. Essentially the treatment will aim at removing or minimising your pain.
There are several options. These include:
- Medications – these include anti-inflammatory drugs, pain killers and muscle relaxants. Nonsteroidal anti-inflammatory medications (NSAIDs) are often effective for both back and neck pain. Tricyclic antidepressants can also be effective.
Topical medications can also bring relief. These are massaged directly into the skin in the painful regions.
- Steroid Injections – epidural steroid injections and steroid injections into the disc spaces, soft tissue or facet joints can bring relief from acute pain.
- Exercise and physical therapy – these are both beneficial for chronic back and neck pain. Generally, exercises are designed to strengthen the muscles in the back and abdomen. Walking can help, as can yoga.
- Self-care – often the pain caused by spondylosis will improve or vanish after a few days, but you are advised to avoid bed rest as this can increase the time you take to recover. Ideally you should continue your life as normal, but without doing anything that might make the condition worse. Heat and ice can also help, and if you have lower back pain then sleeping with a pillow between your legs can help.
- Chiropractic treatments – many people find that specialised chiropractic treatments can be of huge benefit in reducing the pain and reducing the likelihood of it recurring. Sometimes this is combined with alternative therapies such as acupuncture. In a recent study of 36 cervical spondylosis patients treated this way (Xiu, 2015) 22 patients were cured and 14 showed an improvement.
Back and neck pain are some of the most common pains from which people suffer, and levels of pain can be severe and debilitating. Spondylosis is a common though not the only cause. Although it is a degenerative condition that can’t be reversed, there are several ways of managing the pain and of helping the individual reduce its recurrence.
While various medications and steroid injections can help with acute pain, a combination of exercise and physical therapy, chiropractic treatments and alternative therapies, along with proper self-care can bring lasting relief.
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Xiu, L. (2015). Acupuncture and cupping combined with chiropractic massage in the treatment of 36 cervical spondylosis patients. World Journal of Acupuncture – Moxibustion.