ARTHRITIS OF THE SPINE
Arthritis of the Spine – Understanding Your Condition
As you get older, you begin to slow down. It’s just the natural way of things. The activities you once took for granted – climbing stairs, mowing the lawn, even tying your shoes – are not quite as simple as they once were. If you’re fortunate, you can adjust your lifestyle to accommodate the limitations and move on. For millions of people, though, it’s a lot more complicated than that. Aches and pains might begin to develop. Where once you could roll out of bed and get on with your day, your first sensation in the morning might be stiff, warm, or tender joints. Or worse, you may experience waves of pain that shoot through your back or neck and into the extremities.
These are all signs of arthritis, which affects about 50 million Americans and can develop in any joint in the body. It’s not only a problem of late adulthood, either. According to the National Health Interview Survey (NHIS), about two-thirds of arthritis patients are younger than 65, and nearly 300,000 children have juvenile arthritis. By the year 2030, an estimated 67 million Americans aged 18 or older will be diagnosed with some form of arthritis, which is the leading cause of disability in the United States.
Spinal imaging, such as vertebral motion analysis by AOMSI Diagnostics can help evaluate your spine.
More than 100 forms of arthritis have been identified. They all are slightly different, yet they share several characteristics – including the fact that there is no known cure. Also, even though extensive research is ongoing, the precise cause of arthritis remains unknown. What is known is that where there are joints in the body, there is a chance for arthritis to develop. We often think of arthritis as something that strikes the knuckles, wrists, hips, and knees. Indeed, the most common form of arthritis is osteoarthritis, which is the deterioration of cartilage lining the joints. Osteoarthritis is just as likely to affect the joints of the spine as it is the limbs and hands. Arthritis of the spine is one of the most prevalent causes of back and neck pain among adults.
The significant difference between osteoarthritis in the spine and arthritis in, for example, the fingers, is that anatomical degeneration within the spine carries far more potential consequences. Arthritic fingers may impede a typist, but they probably won’t affect that typist’s ability to walk up a flight of stairs. Spinal arthritis, on the other hand, can become a tremendous burden, limiting your ability to move comfortably and indirectly causing excruciating pain in other parts of the body. And even though its causes and cure remain elusive, enough is known about the condition that most spinal arthritis sufferers can, with proper medical care, lead happy, active lives. Education is vital, and it starts with understanding the components of the anatomy that are involved, the potential causes and risk factors, and the symptoms produced by spinal arthritis.
Anatomy of Spinal Arthritis
As mentioned earlier, there are around 100 types of arthritis. The most common, osteoarthritis, must be distinguished from other forms, such as rheumatoid arthritis, ankylosing spondylitis, and many others. The main difference lies in the way osteoarthritis develops. Rheumatoid arthritis, for example, is an autoimmune disease in which the body’s immune system mistakenly attacks healthy joint tissue. By contrast, osteoarthritis is a degenerative ailment, which means the condition progressively worsens as the anatomical components wear down through use. Although it is not clear why some people develop spinal osteoarthritis and others do not, it is understood that this form of arthritis is related to the natural deterioration of the anatomical components of the spine. The elements directly related to the development of spinal osteoarthritis include:
Vertebrae – These are the building blocks of the spine, 33 bones stacked from the base of the skull to the tailbone (coccyx). There are 24 flexible vertebrae and nine vertebrae that are fused in the pelvic region and coccyx.
Facet joints – These joints are formed where the flexible vertebrae meet. Facet joints occur in pairs along the length of the spine and allow for a wide range of neck and back movement. These vertebral joints are encased in cartilage and lubricated by synovial fluid.
Intervertebral discs – These kidney bean-shaped wedges of cartilage and gelatinous protein are located between the vertebrae and serve as sponge-like cushions. They are composed of two main parts: a gel-like center called the nucleus pulposus, and a layered outer wall called the annulus fibrosus.
As you age, the vertebrae, facet joints, and intervertebral discs are exposed to a great deal of wear and tear. This is particularly true in two regions of the spine: the cervical (neck) region and the lumbar (lower back) region. The cervical region is composed of the seven top-most vertebrae, which support the weight of the skull and are flexible enough to allow for a wide range of head, neck, and shoulder movement. The lumbar region is made up of five (in rare cases, six) vertebrae toward the bottom of the spine. This area absorbs most of the weight of the upper body, in addition to being flexible enough to allow the lower spine to facilitate bending, twisting, turning, and other movements. Considering the weight, they bear and the actions they make possible, it comes as no surprise that the most common locations for spinal osteoarthritis to occur are the neck and lower back.
How, then, does spinal osteoarthritis progress?
It starts, as mentioned, with the deterioration of the anatomical components. In most people, deterioration begins in early adulthood, when the ability of the intervertebral discs to retain water starts to diminish slowly. The nucleus of a disc is almost entirely liquid, which gives the disc its height and elasticity. Less water content means less disc height, which brings the bony vertebral bodies closer together. A reduction in disc height also places more stress on the facet joints, which must work harder to keep the vertebrae from the meeting. Extra stress on the joints increases the rate of deterioration of the joint cartilage, which begins to wear away, threatening the stability of the vertebral segment. This reduction in stability, in turn, can trigger the production of osteophytes, or bone spurs, which are smooth protrusions of excess bone that grow near the joints along the edges of affected vertebrae.
Combined, all of this deterioration and bone spur growth can cause havoc – although not necessarily. The body has a way of adjusting to physical changes, and even spinal osteoarthritis might produce nothing more severe than joint stiffness, a slight reduction in mobility, or occasional twinges of pain.
The real problem for spinal osteoarthritis sufferers is the increased potential for nerve compression. In addition to the physical infrastructure of bone, muscle tissue, ligaments, blood vessels, and cartilaginous structures, the spinal column houses two essential components of the nervous system:
The spinal cord – This is an elongated bundle of nerve fibers that transmits sensory and motor signals between the brain and the rest of the body. It is about the diameter of a human finger and runs from the base of the skull to the top of the lumbar spine, where it splits off into a horsetail-shaped configuration of nerves known as the cauda equina.
Nerve roots – These are the initial segments of nerves that branch off the spinal cord and serve as conduits between the central nervous system and the rest of the body. Thirty-one pairs of nerve roots exit the spinal column through intervertebral openings known as foramina.
Spinal osteoarthritis, as mentioned, can dramatically reshape the bones and other anatomical structures of the spine. The spinal cord and nerve roots already-fit rather snugly in the spaces allotted to them, so any anatomical change – especially those related to arthritis – can affect the adjacent nerve structures. For instance, bone spurs associated with osteoarthritis often grow along the edges of the foramina, where the nerve roots exit the spinal column. If a bone spur makes contact with a nerve root, it interferes with the ability of the root to transmit sensory or motor signals.
Worse yet, it activates the messages that produce neuropathic pain, which can be felt in parts of the body innervated by the compressed nerve. A well-known example of this is the set of symptoms known as sciatica, which occur when the sciatic nerve is compressed in the lower back. Sciatica is a prevalent result of osteoarthritis in the lower spine, primarily because the sciatic nerve – the longest and largest nerve in the body – is tucked in among components of the spinal anatomy that are most vulnerable to age-related deterioration.
If you suffer from arthritis-related sciatica or other symptoms, you naturally want to know two things (not necessarily in this order): how it happened, and how to make it stop. Read on for answers.
Causes and Risk Factors of Arthritis
As you now know, the causes of spinal osteoarthritis have not been definitively confirmed by the scientific community. However, the vast amount of research into the potential origins of arthritis has revealed volumes of information that can shed some light on the question. Even as the underlying causes remain a mystery, the research has enabled doctors to identify groups of people who might be more at risk for developing spinal osteoarthritis. It should come as no surprise that people who are middle-aged and older form, by far, the largest at-risk group.
With osteoarthritis, there remains little doubt that the natural aging process is a significant factor. Joint cartilage is exposed to so much wear and tear over the years, it is logical to expect a certain amount of physical repercussion, and that often takes the form of osteoarthritis. Cartilage deterioration most often begins to manifest itself after the age of 45, and about half of all people 65 or older have been diagnosed with some form of arthritis. As remarkable a factor as it is, the aging process is not entirely responsible for the development of osteoarthritis. Otherwise, everyone of a certain age would be diagnosed with the condition. Other potential risk factors for the development of spinal arthritis have been identified. These include:
Genetics – If a close relative has arthritis, there appears to be a better chance that you will develop the condition, as well. This apparent genetic component remains the subject of intense research. By identifying the genetic link, researchers hope to get one step closer to a potential cure.
Spinal trauma – If you ever suffered a back or neck injury, as in a car accident or a violent collision while playing sports, the injured joint is likely to degenerate prematurely or have spinal instability
Smoking – Nicotine and other chemicals in cigarette, pipe, or cigar smoke can reduce the body’s ability to circulate oxygen and essential nutrients, threatening the health of the spinal anatomy.
Obesity – Research has shown that people who have arthritis are 54 percent more likely to be significantly overweight than people who do not have arthritis. What this reveals is that carrying excess body weight places additional stress on the joints of the spine, which accelerates cartilage degeneration.
Gender – According to the NHIS, 25.9 percent of women and 18.3 percent of men have been diagnosed with some form of arthritis. This disparity among men and women begins to even out after age 50.
Repetitive movement – If your occupation or pastime involves a lot of turning, bending, twisting, or lifting, you may be exposing the vertebral joints to excess strain. Similarly, truck drivers and others whose professions require long periods of sitting are at risk for accelerated joint deterioration, especially in the lower back.
Even if you fall into one of the categories listed above, it doesn’t mean you are doomed to a life of arthritic discomfort. Not everyone in an at-risk group develops spinal arthritis, and not everyone who has spinal arthritis suffers debilitating life-altering symptoms. Most people with the condition can lead to happy, healthy, active lives by working closely with their doctors to develop a treatment plan. Of course, before a treatment plan is established, the doctor must diagnose the condition. And you can help by learning as much as possible about the symptoms of spinal arthritis and describing those that you experience to your doctor in as much detail as you can.
Arthritis of the Spine – Symptoms
It can start with a mild ache or a warm sensation within the neck or lower back. You might wake up with a stiff neck, or find it difficult to bend at the waist after strenuous activity. And that popping or grinding sound when you turn your head or bend down to tie your shoes … what’s that about?
These are all early signs that you may be developing osteoarthritis of the spine. As the joint cartilage begins to deteriorate, small nerve endings are exposed, and adjacent soft tissue might become inflamed. This is where the initial ache or feeling of warmth comes from. During sleep, the spinal joints might “settle,” or lock, which is what causes the stiffness. The strange popping sound (called crepitus) might be the bones of the joints grinding together, or it might be bone spurs making contact with a vertebra above or below. For many people living with spinal arthritis, these symptoms are as severe as it gets. Others are not so fortunate.
The most insidious symptoms of spinal osteoarthritis are those produced by nerve compression, the mechanics of which were described earlier. Sciatica is an example of spinal nerve compression, and here’s how it might feel to you:
A shooting pain that originates in the lower back travels down the buttocks and extends into one leg or the other
A tingling sensation in one of your legs, feet, or toes
Numbness in the lower extremities, especially the feet or toes
Unexplained weakness in the legs
A dull ache in one of your hamstring muscles
Similarly, if nerve compression occurs in the cervical region of the spine, it can cause pain, tingling, numbness, or muscle weakness in the shoulders, upper back, arms, hands, or fingers.
The severity of these symptoms will vary from person to person, as will the rate of occurrence. Some people living with spinal arthritis complain of constant discomfort, while others experience symptoms only intermittently. Also, not every patient experiences the entire range of potential symptoms. Because spinal arthritis can produce such a wide variety of symptoms, you need to provide as much detail as possible to your doctor. It might be a good idea to keep a journal of your symptoms, recording the sensation, the area of the body affected, the time of day or night, and what you were doing when it occurred. That way, you’ll be prepared to answer your doctor’s questions if and when you make your initial visit. Once a diagnosis of spinal arthritis is confirmed, you can work closely with your doctor to develop a treatment plan. Communication between you and your doctor will remain crucial throughout treatment, so pay close attention to how your symptoms respond – and write it down.
Arthritis of the Spine – Procedures and Vertebral Motion Analysis by AOMSI Diagnostics
You may have already attempted a number of conservative, nonsurgical treatments that your doctor suggested to help you find relief from your spinal osteoarthritis. But if you’ve failed to find relief through any of these treatments after several weeks or months, surgery may become an option.