Spondylosis
What Is Spondylosis?
Spondylosis (spinal osteoarthritis)
is a degenerative disorder that may cause loss of normal spinal structure
and function. Although aging is the primary cause, the location and rate
of degeneration is individual. The degenerative process of spondylosis may
impact the cervical, thoracic, and/or lumbar regions of the spine
affecting the intervertebral discs and facet joints.
What are the types of spondylosis?
Lumbar spondylosis refers to any narrowing of the
spinal canal. Cervical Spondylosis refers to a degenerative process of the
cervical spine producing narrowing of the spinal canal producing
compression of the spinal cord and nerve roots
What are the
Causes and symptoms?
As people age, shrinkage of the vertebral disks
prompts the vertebrae to form osteophytes to stabilize the back bone.
However, the position and alignment of the disks and vertebrae may shift
despite the osteophytes. Symptoms may arise from problems with one or more
disks or vertebrae.
Osteophyte formation and other changes do not
necessarily lead to symptoms, but after age 50, half of the population
experiences occasional neck pain and stiffness. As disks degenerate, the
cervical spine becomes less stable, and the neck is more vulnerable to
injuries, including muscle and ligament strains. Contact between the edges
of the vertebrae can also cause pain. In some people, this pain may be
referred--that is, perceived as occurring in the head, shoulders, or
chest, rather than the neck. Other symptoms may include vertigo (a type of
dizziness) or ringing in the ears.
The neck pain and stiffness can be intermittent,
as can symptoms of radiculopathy. Radiculopathy refers to compression on
the base, or root, of nerves that lead away from the spinal cord.
Normally, these nerves fit comfortably through spaces between the
vertebrae. These spaces are called intervertebral foramina. As the
osteophytes form, they can impinge on this area and gradually make the fit
between the vertebrae too snug.
The poor fit increases the chances that a minor
incident, such as overdoing normal activities, may place excess pressure
on the nerve root, sometimes referred to as a pinched nerve. Pressure may
also accumulate as a direct consequence of osteophyte formation. The
pressure on the nerve root causes severe shooting pain in the neck, arms,
shoulder, and/or upper back, depending on which nerve roots of the
cervical spine are affected. The pain is often aggravated by movement, but
in most cases, symptoms resolve within four to six weeks.
Cervical spondylosis can cause cervical
spondylitic myelopathy through stenosis- or osteophyte-related pressure on
the spinal cord. Spinal stenosis is a narrowing of the spinal
canal-- the area through the center of the vertebral column occupied by
the spinal cord. Stenosis occurs because of misaligned vertebrae and
out-of-place or degenerating disks. The problems created by spondylosis
can be exacerbated if a person has a naturally narrow spinal canal.
Pressure against the spinal cord can also be created by osteophytes
forming on the inner surface of vertebrae and pushing against the spinal
cord. Stenosis or osteophytes can compress the spinal cord and its blood
vessels, impeding or choking off needed nutrients to the spinal cord
cells; in effect, the cells starve to death.
With the death of these cells, the functions that
they once performed are impaired. These functions may include conveying
sensory information to the brain or transmitting the brain's commands to
voluntary muscles. Pain is usually absent, but a person may experience leg
numbness and an inability to make the legs move properly. Other symptoms
can include clumsiness and weakness in the hands, stiffness and weakness
in the legs, and spontaneous twitches in the legs. A person's ability to
walk is affected, and a wide-legged, shuffling gait is sometimes adopted
to compensate for the lack of sensation in the legs and the accompanying,
realistic fear of falling. In very few cases, bladder control becomes a
problem.
Diagnosis
Cervical spondylosis is often suspected based on
the symptoms and their history. Careful neurological examination can help
determine which nerve roots are involved, based on the location of the
pain and numbness, and the pattern of weakness and changes in reflex
responses. To confirm the suspected diagnosis, and to rule out other
possibilities, imaging tests are ordered. The first test is an x ray. X
rays reveal the presence of osteophytes, stenosis, constricted space
between the vertebrae, and misalignment in the cervical spine--in short,
an x ray confirms that a person has cervical spondylosis. To demonstrate
that the condition is causing the symptoms, more details are needed. Other
imaging tests, such as magnetic resonance imaging (MRI) and
computed tomography myelography, help assess effects of cervical
spondylosis on associated nerve tissue and blood vessels.
An MRI may be preferred, because it is a
noninvasive procedure and does not require injecting a contrast medium as
does computed tomography myelography. MRIs also have greater sensitivity
for detecting disk problems and spinal cord involvement, and the test
allows the physician to create images of a larger area from various
angles. However, these images may not show enough detail about the
vertebrae themselves. Computed tomography myelography yields a superior
image of the bones involved in cervical spondylosis. Added benefits
include that it takes less time to perform and tends to be less expensive
than an MRI. A good diagnosis may be reached with either a computed
tomography myelography or an MRI, but sometimes complementary information
from both tests is necessary. Nerve conduction velocity, electromyogram (EMG),
and/or somatosensory evoked potential testing may help to confirm which
nerve roots are involved.
Treatment
When possible, conservative treatment of symptoms
is preferred. Conservative treatment begins with rest--either restricting
normal activities to a less strenuous level or bed rest for three to five
days. If rest is not adequate to relieve symptoms, a cervical orthosis may
be prescribed, such as a soft cervical collar or stiffer neck brace to
restrict neck movement and shift some of the head's weight from the neck
to the shoulders. Cervical traction may also be suggested, either
at home with the advice of a physical therapist or in a health-care
setting.
Pain is treated with nonsteroidal
anti-inflammatory drugs, such as aspirin or ibuprofen. If these
drugs are ineffective, a short-term prescription for corticosteroids
or muscle relaxants may be given. For chronic pain, tricyclic
antidepressants can be prescribed. Although these drugs were developed to
treat depression, they are also effective in treating pain. Once any pain
is resolved, exercises to strengthen neck muscle and preserve flexibility
are prescribed.
If the pain is severe, a short treatment of
epidural corticosteroids may be prescribed with discretion. A
corticosteroid such as prednisone can be combined with an anaesthetic and
injected with a long needle into the space between the damaged disk and
the covering of the nerve and spinal cord. Injection into the cervical
epidural space relieves severe pain that is not managed with conventional
treatment. Frequent use of this treatment is not medically recommended and
is used only if the more conservative therapy is not effective.
If pain is continuous and does not respond to
conservative treatment, surgery may be suggested. Surgery is usually not
recommended for neck pain, but it may be necessary to address
radiculopathy and myelopathy. Surgery is particularly recommended for
people who have already developed moderate to severe symptoms of
myelopathy, although age or poor health may prohibit that recommendation.
The specific details of the surgery depend on the structures involved, but
the overall goal is to relieve pressure on the nerve root, spinal cord, or
blood vessels and to stabilize the spine.
Alternative treatment
Alternative therapy is not meant to replace
conventional medical treatment, but it can be a useful adjunct. Its main
roles are to relieve tension, manage pain, and strengthen neck and back
muscles.
Magnet therapy: The application of high
strength rare earth magnets at the point of pain. The magnets should be
applied continuously over a period of at least 3 weeks.
Magnets can be applied in the form of straps,
wraps, insoles, jewellery, pillows, mattress
covers.Massage is one way to relieve tension, and yoga provides the
additional benefit of strengthening muscles. Chiropractic and
acupuncture have been reported to relieve the pain associated with
disk problems, although great care needs to be taken to avoid exacerbating
them. Practitioners of the Alexander technique or the
Feldenkrais method can provide instruction on correct posture and
exercise that may help prevent further symptoms. Vitamin and mineral
supplementation along with herbal therapies and homeopathy can help
build and rebalance the weakened structure.
Prognosis
The gradual progression of cervical spondylosis
cannot be stopped; however, it doesn't always cause symptoms. For the
individuals who do experience problems, conservative treatment is very
effective in managing the symptoms. Nearly all people with neck pain,
approximately 75% of persons with radiculopathy, and up to 50% of people
with myelopathy find relief through therapy alone. For the remaining
people with radiculopathy or myelopathy, surgery may be recommended.
Surgery is deemed successful in 70-80% of cases.
Prevention
Since cervical spondylosis is part of the normal
aging process, not much can be done to prevent it. It may be
possible to ward off some or all of the symptoms by engaging in regular
physical exercise and limiting occupational or recreational activities
that place pressure on the head, neck, and shoulders. The best exercises
for the health of the cervical spine are noncontact activities, such as
swimming, walking, or yoga. Once symptoms have already developed, the
emphasis is on symptom management rather than prevention.
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