Doctor's Notes on Spondylosis
Spondylosis refers to degeneration of the disc spaces between the vertebrae of the spinal column. Aging is the most common cause of spondylosis. With normal aging, the dics start to lose moisture and become shrunken. Spondylosis can affect different regions of the spine in both the neck and back, and it can be present in more than one area of the spine. Cervical spondylosis refers to degeneration of the disc spaces between the vertebrae of the neck.
Spondylosis may be mild and not lead to any specific symptoms or signs. When it is severe, it can cause pain and stiffness or decreased range of motion of the spine. In some cases, spondylosis results in a narrowing of the area of the spinal cord and the nerve roots exiting from the spinal cord. If these nerves are pinched or compressed, associated symptoms can include weakness, numbness, or tingling in the extremities, gait disturbances, coordination problems, or loss of bowel or bladder control.
Many people with spondylosis on X-ray do not have any symptoms. In fact, lumbar spondylosis (spondylosis in the low back) is present in 27%-37% of people without symptoms. In some people, spondylosis causes back pain and neck pain due to nerve compression (pinched nerves). Pinched nerves in the neck can cause pain in the neck or shoulders and headache. 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.
Characteristic findings of spondylosis can be visualized with X-ray tests. These 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.
Symptoms of spondylosis include localized pain in the area of spondylosis, usually in the back or neck. Spondylosis in the cervical spine (neck) can cause headache. However, it is controversial whether more mild spondylosis, such as small bone spurs and bulging discs that do not compress nerves, causes back pain. This is because most middle-aged and elderly people have abnormal findings on X-ray tests of spondylosis, even when they are completely pain free. Therefore, other factors are likely major contributors to back pain.
If a herniated disc from spondylosis 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 radiates into the legs. This is called radiculopathy. When the sciatic nerve, which runs from the low back down the leg to the foot, is affected, it is called sciatica. Radiculopathy and sciatica often cause numbness and tingling (sensation of pins and needles) in an extremity. 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). Spondylosis with myelopathy refers to spondylosis that is injuring the spinal cord. Spondylosis without myelopathy refers to spondylosis without any injury to the spinal cord. 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.
Spondylosis is an aging phenomenon. With age, the bones and ligaments in the spine wear, leading to bone spurs (osteoarthritis). Also, the intervertebral discs degenerate and weaken, which can lead to disc herniation and bulging discs. Spondylosis is common. Symptoms are often first reported between the ages of 20 and 50. Over 80% of people over the age of 40 have evidence of spondylosis on X-ray studies. The rate at which spondylosis occurs is partly related to genetic predisposition as well as injury history.
Genetics is another risk factor for spondylosis. If many people in a family have spondylosis, there is likely to be a stronger genetic predisposition to spondylosis.
Spinal injury is also a risk factor for spondylosis. Injuries can cause intervertebral discs to herniate. Also, osteoarthritis is more likely to develop in injured joints, including joints in the spine. This can take years to develop.
Osteoarthritis is a progressive form of arthritis characterized by breakdown of the cartilage in joints. Osteoarthritis (OA), also known as degenerative joint disease and "wear and tear" arthritis, causes pain in the joints with activity. The knees and the hips are common locations for osteoarthritis. Osteoarthritis is common in people over 60 years of age, but it can affect younger people, particularly where they have had joint injury or joint surgery.
Rheumatoid Arthritis : What is Rheumatoid Arthritis? QuizQuestion
The term arthritis refers to stiffness in the joints.See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.