SPONDYLOSIS

August 5, 2020 Nicholas Lancaster

Spondylosis – Understanding Your Condition

Spondylosis is a general term, not a scientific diagnosis. In essence, it is a catch-all phrase used by some doctors to describe age-related degeneration within the spine, usually accompanied by the appearance of osteophytes (bone spurs). Other doctors may use the term to refer specifically to spinal osteoarthritis. Still others might use another term – spondylotic myelopathy – to refer to the same condition. This inconsistent usage can be confusing, especially when medical professionals mention similar-sounding terms such as ankylosing spondylitis, spondylolysis, and spondylolisthesis. These spine conditions are not to be confused with spondylosis, and they will be further explored below. For now, it’s enough to know that if you are told by a diagnostician that you suffer from spondylosis, you’re going to need to know more details before you truly understand the underlying condition causing you so much neck pain, back pain, or other symptoms.

One reason so many different spine conditions are referred to by names that start with “spondy” is that they all derive from the Greek word spondyl, which is defined specifically as a vertebra or, more generally, as related to the spine. The suffix -osis, also of Greek origin, refers to an abnormal state or disorder. Put them together to form “spondylosis” and you get, in layman’s terms, “back problem.” In all likelihood, before you ever went to the doctor, you probably suspected that you had a back problem based on the neck or back pain that prompted you to seek medical attention in the first place. What you want to know, of course, is what kind of back problem is it? What caused it? Why did you develop it? And how can it be treated?

One way to shed more light on a spondylosis diagnosis is to learn more about the particular degenerative spine conditions that could be behind it. Your spondylosis crash course starts with a look at the anatomy of the spine.

Anatomy

Spondylosis can refer to disorders related to almost any component of the spine’s anatomy, and quite often, more than one component is involved. In general, when the term spondylosis is used, it means the condition is related to the deterioration of the spinal column, which occurs naturally as we age. Unless we are stricken by a degenerative spine condition, we don’t often think about the stress our backs are subjected to on a daily basis. But nearly every movement we make, and every bodily position we maintain, requires the spine to be employed in some capacity – even the relatively sedentary acts of sitting still or lying down.

The wide range of stress-inducing spinal movements, coupled with the burden of carrying the weight of the upper body and head, can take a tremendous toll on the spine’s anatomy. Here’s a breakdown of the major structural components of the spine, along with the potential effects of the aging process:

Vertebrae – These are the building blocks of the spine, typically 33 vertically stacked vertebrae, starting at the top with the seven cervical vertebrae in the neck, and running downward through the thoracic spine (12), lumbar spine (5), sacrum (5), and coccyx (3-5). The vertebrae of the sacrum and coccyx become fused in early childhood.
Facet joints – The top 24 vertebrae meet and move at paired joints called facet joints. These joints are lined with cartilage and encased in synovial fluid to allow for smooth movement, and they bear a great deal of the weight burden that is placed on the upper and lower spine.
Intervertebral discs – These circular pads serve as cushions between vertebrae. They are composed of inner gel-like material enclosed within elastic layers of cartilage and, along with the facet joints, allow the spine to move. Intervertebral discs have two main parts: the gel-like center, or nucleus pulposus; and the layered outer wall, or annulus fibrosus. Discs are the largest non-vascularized structures in the body and each disc is connected to the vertebra above and below it by vertebral endplates.
Ligamenta flava – These ligaments help stabilize and connect adjacent vertebrae. A ligamentum flavum typically is located to the rear of the intervertebral disc.

As the body ages, all of these components undergo physical changes, mostly based on the amount of stress they’ve been subjected to over the years. In general, the intervertebral discs are the first spinal components to wear down significantly, and because they are composed mostly of cartilage – which heals very slowly if at all – they do not naturally regenerate in the same way that, for instance, a broken bone does. Disc deterioration – or any sort of spinal degeneration, for that matter – can occur at any level of the spine. It is expedited within the cervical (neck) and lumbar (lower back) regions, because those two areas of the spine are most flexible and bear the most weight.

There are several different degenerative spine conditions that could be responsible for a diagnosis of spondylosis. Here are three of the most common:

Osteoarthritis – The cartilage that lines the facet joints begins to wear down, reducing the joints’ ability to articulate smoothly and endangering the stability of the affected vertebral segment. The body responds to the increased friction and reduced spinal stability by producing excess growths of bone known as osteophytes (bone spurs). These smooth bony protrusions grow along the edges of the vertebrae.
Degenerative disc disease – Over time, discs begin to lose water content within the gel-like center and the layered outer wall begins to weaken and becomes brittle. These physical changes lead to a reduction in the height of the disc, which inhibits the mobility of the affected vertebral segment. In some cases, the weakened outer wall of a disc is forced out of its normal boundary because it can no longer withstand the pressure placed on it by the inner nucleus. This is known as a bulging disc. Should the outer wall form a tear or crack, nucleus material can begin to leak out of the center and into the spinal canal. This is called a herniated disc.
Spinal stenosis – Like spondylosis, this is a general term referring to a reduction of space within the spinal canal. This space is occupied by neural components, including the spinal cord and nerve roots. Stenosis, or narrowing, can occur within the canal itself, or within the openings that allow for the passage of nerve roots branching off the spinal cord. These openings are located on either side of the vertebrae and are known as foramina (singular: foramen). Stenosis can also occur if someone is born with a spinal canal that is narrower than normal.

In most cases, the degenerative spine conditions that lead to the development of spondylosis remain asymptomatic. Or, if symptoms are present, at first they may feel like the normal aches, pains, and stiffness that people expect in later years. However, if the deterioration of the physical infrastructure of the spine leads to the irritation of nerve endings in the facet joints, chronic back and neck pain may greatly infringe on an individual’s quality of life. Furthermore, if degeneration in the spinal column results in the compression of a nerve root or the spinal cord, it can lead to debilitating symptoms known as radiculopathy, which are explained in more detail later on, under the heading, “Symptoms of Spondylosis.”

Before we move on to the causes and risk factors of spondylosis, a quick note should be made on the other spinal conditions whose names bear such a close resemblance. As mentioned earlier, “spondyl” is Greek for “of or related to the spine.” We already know that spondylosis is, basically, back trouble. What, then, are these other conditions? To begin with, they (like spondylosis) are often a result of the aging process – although, this is not always the case. Spondylolisthesis is a slippage of one vertebra over another. Ankylosing spondylitis is a form of spinal arthritis that tends to be diagnosed in individuals between the ages of 15 and 45. Spondylolysis is a stress fracture within a vertebra. The lesson here is that if you are in the process of having back or neck pain diagnosed, pay very close attention to every syllable of words that begin with the prefix “spondyl.”

Causes and Risk Factors

Although everyone experiences some spinal degeneration as they age, not everyone develops debilitating symptoms. Why is that? And is it possible to predict whether you will face life-altering back or neck problems as you get older? The answers to these questions remain elusive, but there are certain risk factors and external causes that appear to make some more vulnerable than others to the development of symptomatic spondylosis. These risk factors and causes include:

Aging – Although this was mentioned earlier, it bears repeating here. A certain amount of spinal deterioration can be anticipated for everyone, and the preponderance of spine patients are middle-aged and elderly. However, keep in mind that anatomical degeneration takes place at different rates for everyone, and some individuals may be affected in their 30s and even in their 20s. For the most part, though, degenerative spine conditions are primarily diagnosed in people in their 50s and older.
Obesity – As you might suspect, carrying extra body weight takes a serious toll on the components of the spinal anatomy. The lumbar spine, in particular, is susceptible to weight-related wear and tear, because the lower back bears most of the weight of the upper body. Extra weight places more stress on all the parts that make up the spine, including the facet joints and intervertebral discs. Obesity can also inhibit the body’s circulation, which makes it more difficult for the discs and other components of the spine to receive vital nutrients.
Poor posture – You probably heard it from your caregivers throughout your youth – sit up straight! There is no better advice when it comes to maintaining long-term spine health. Habitually slouching while seated, or slumping your shoulders while standing, can contribute to accelerated anatomical deterioration.
Repetitive stress – If your job or pastime requires repeated heavy lifting or sustained periods of sitting, the joints of the spine are forced to work even harder. Many people are surprised to learn that, when they’re in a seated position, their lower spine endures a great amount of stress because it must prop up the entire upper body. At least when we stand, the legs take on some of the burden. In addition to the joints, the intervertebral discs are subjected to repetitive movements throughout the day and the gravitational forces of sitting, as well, further contributing to the deterioration process.
Inherited traits – While the origins of certain degenerative spine conditions remain somewhat uncertain, it is believed that there is a congenital element. For example, if one of your parents or grandparents had spinal osteoarthritis, it is understood that you have a better chance of developing the condition. The same can be said of other conditions, such as degenerative disc disease.
Tumors and traumatic injury – Not all spine problems develop as a result of aging. Spinal tumors (malignant or benign), while uncommon, can lead to symptoms similar to those produced by degenerative spine conditions. Traumatic injury, as endured in a car accident, for example, might also disrupt the spinal anatomy. Similarly, injuries sustained early in life – such as those incurred while playing contact sports or participating in gymnastics during the teenage years – can cause spine problems later on.

Personal habits also can be contributing factors to the acceleration of spinal deterioration. For instance, smoking causes circulation issues. An unhealthy diet can lead to obesity, as well as a lack of nutrients that are essential for maintaining healthy bones, muscles, and other spinal tissues. Finally, a sedentary lifestyle can bring about weight problems, as well as weakened back and neck muscles. If you are within one of these at-risk groups, talk to your doctor about ways to slow or mitigate the inevitable degeneration of the components of your spinal anatomy.

Spondylosis Symptoms

Localized pain and a reduction in range of motion are the two most telling symptoms of potential spondylosis. The severity and type of pain depends on the particular condition. For instance, someone with osteoarthritis in the cervical region might wake up in the morning with a dull ache and/or stiffness in the neck. Meanwhile, someone with spinal stenosis in the lumbar region might experience recurring radiating pain down the back of one leg or the other. While these symptoms could be (and often are) attributable to a muscle strain or ligament sprain, chronic reoccurrence of the discomfort is an indication that the condition is related to a degenerative spine condition. “Chronic” is loosely defined as symptoms that last for longer than three months.

Often, a diagnosis of spondylosis will be applied to back pain and related symptoms that don’t have an obvious root cause. Further diagnostic testing may be required to pinpoint the source of the pain. X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, and other tools are often used to confirm a diagnosis.

While spondylosis does not always lead to spinal nerve compression, many of the degenerative spine conditions associated with spondylosis can threaten to infringe upon the spine’s neural components. Bone spurs, or osteophytes, that grow too large or in just the right areas of the spine can “pinch,” or impinge a spinal nerve root. This can produce the set of symptoms known as radiculopathy, or symptoms that travel along the path of the affected nerve, which might include:

Radiating pain
Tingling
Numbness
Muscle weakness

The region of the spine where nerve compression occurs will determine the area or areas of the body affected by symptoms. For example, a pinched nerve within the cervical region can produce symptoms that are felt in the shoulders, arms, hands, fingers, and upper back. Nerve compression in the lumbar region affects the lower back, the buttocks, the legs, the feet, and the toes.

If you begin to experience these symptoms, when should you consider visiting the doctor? No two cases are alike, and only you can determine your pain threshold. However, even if the pain and other symptoms are not bad enough to rob you of mobility, you should not allow it to remain undiagnosed. A standard rule of thumb might be to see a doctor if the pain lasts for longer than a few days. When you do visit the doctor’s office, come prepared to answer questions about the nature and severity of your symptoms, about your medical history and that of your immediate family, and about what types of home treatment you attempted before seeking professional medical help. Communication is key, because identifying and treating the underlying cause of spondylosis is a matter of teamwork between you and your healthcare providers.

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