Spondylosis Symptoms, Causes, Diagnosis and Treatment

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The Universal Guide to Spondylosis: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Spondylosis?   |    Bone Spurs   |    Symptoms    |    Risk Factors    |    Diagnosis   |    Nonoperative Treatments  |    Surgery Options    |    Complementary and Alternative Treatmens   |    Lifestyle Changes   |    Sources

Spondylosis can feel like a metaphor for the aging process. That slow march of wear and tear is happening to us all, whether we feel it or see it. One day you look in the mirror and think, “Where’d all this salt-and-pepper hair come from?” Spondylosis can be sneaky like that, except instead of grey hairs you get back pain. Yay.

Senior woman suffering from a backache sitting on a bed in a bedroomSpondylosis is a degenerative condition that may worsen as a person grows older. It can affect any region of the spine. Photo Source: 123RF.com.Technically, spondylosis is a form of arthritis—spinal osteoarthritis (osteoarthritis is the most common type of arthritis) to be exact. We tend to think of arthritis as something you get in your hands and knees, but the spine, and all of its bones and joints, can fall victim to its grip as well. And yes, while it’s most likely to affect people in the 60+ range, patients typically report their first symptoms between the ages of 20 and 50 years (massive range, right?).

More than 80% of people older than 40 years show evidence of the condition on X-rays. Lumbar, or lower back, spondylosis is especially common in people older than 40 years. According to the Arthritis Foundation, spinal osteoarthritis may affect as many as 75% of everyone over the age of 60.

Nobody (except little kids) wants to get older, but you have to. But you don’t have to get spondylosis, and if you do get it, you don’t have to let it destroy your quality of life. Here’s everything you need to know about spondylosis: Its causes and symptoms, how it’s diagnosed, and maybe most important, how to manage and prevent it.

What is Spondylosis?

Spondylosis describes the general degeneration of the spine that can occur in joints, discs, and bones of the spine as we age.

“Arthritis” is an umbrella term for more than 100 conditions that cause painful joints, and in the case of spondylosis, the spine is full of joints that can be affected. Osteoarthritis—which is what spondylosis is—is the most common type.

Bones in a joint need to glide smoothly together. Articular cartilage, which is cartilage that wraps the ends of bones in a joint, allows that smooth gliding and helps prevent painful and damaging bone-on-bone contact. Osteoarthritis is the gradual breakdown of this cartilage. It’s also known as wear-and-tear arthritis, because it just sort of happens naturally over a lifetime of joint movement.

Your spine is a column made of 33 bones called vertebrae. Cushion-like pads called discs are tucked between most vertebrae, which protects the spine and makes it flexible. And within this column of vertebrae lies the spinal cord. Vertebrae are connected by facet joints, which are the victims in spondylosis.

Spondylosis is common, but it is usually not serious. Many who have it experience no pain, though it can be painful for some. Most patients with spinal osteoarthritis will not need surgery. However, it is a degenerative condition that may worsen as a person grows older, and can affect any region of the spine, including:

  • Cervical — neck
  • Thoracic — upper, mid-back
  • Lumbar — low back
  • Lumbosacral — low back/sacrum

How Does Spondylosis Affect Discs and Cause Bone Spurs to Form?

To better understand the implications of spondylosis, it helps to learn about the challenges that can arise. Intervertebral discs serve as the cushion between the bone and function as a major shock absorber by retaining water. As we age, the discs begin to dry out and, as a result, can lose their shock-absorbing capability, transmitting more load to the vertebrae, sometimes resulting in bone spur formation (that’s degenerative disc disease, or DDD). Our bodies respond to stress by forming bone in an attempt to stabilize the segment.

Axial view of spinal nerve compressionBone spurs can pinch a spinal nerve root and cause inflammation and pain. Photo Source: SpineUniverse.com.Spinal osteoarthritis also affects the facet joints of the vertebrae — which is why it is also known as facet joint syndrome, facet joint arthritis, or facet disease. And, DDD may contribute to the problem. As the discs between the vertebrae become thinner, more pressure is placed on the facet joints, leading to more friction and, subsequently, damage to the cartilage.

Barrett Woods, MD, a board certified orthopedic surgeon with Rothman Orthopaedic Institute at AtlantiCare, and assistant professor of spine surgery at Thomas Jefferson University Hospital, says that in facet joints, just like a knee or hip, “the cartilage surfaces breaks down, causing bones to rub together, which can form bone spurs or enlarge the joint (hypertrophy) in an attempt to stabilize the segment.”

What Are Spondylosis Symptoms?

Symptoms for Spondylosis The most common symptoms of spondylosis.

While spondylosis can affect the joints anywhere along the spine, it occurs more commonly in the neck and low back. The neck is susceptible because it supports the head's weight throughout a wide range of movement—according to the American Academy of Orthopaedic Surgeons, more than 85% of those over the age of 60 have cervical spondylosis. The low back is at risk because it manages and distributes most of the body’s weight and related structural stresses. More than 80% of those over the age of 40 may have lumbar spondylosis in the United States, though the majority are asymptomatic (have no symptoms and feel no pain).

Although many with the condition do experience varying levels of discomfort, the positive news is that spondylosis does not always cause pain. According to Dr. Woods, “when spondylosis of the spine does result in pain, it is non-radiating, but can affect range of motion. If the spondylosis progresses to compressing the nerves in the neck or lower back, it will likely result in pain numbness or weakness in the arms and legs.”

Common symptoms can include:

  • Stiffness, particularly after periods of inactivity or rest, such as waking up after a nap.
  • Paresthesias, or abnormal sensations, may develop — such as numbness or tingling.
  • Limited range of motion in affected joints.
  • Pain can result from a bulging or herniated disc that impinges or pinches a spinal nerve (see diagram below). Nerves compressed in the neck can cause neck pain to radiate down into the shoulder, arm, and hand. Similarly, if the low back is affected, the patient may experience buttock pain and sciatica, a type of nerve-related leg pain.

While not as common, Dr. Woods pointed out that “spondylosis can affect the alignment of the back, which can make it difficult to stand upright.”

What Are Risk Factors for Developing Spondylosis?

While spondylosis is often associated with aging, certain genetic predispositions, and injuries may increase a person’s risk of developing spinal osteoarthritis. Aside from normal wear and tear and specific autoimmune triggers, in many cases of spondylosis, the cause remains unknown.

According to Dr. Jacob LaSalle, board certified anesthesiologist and pain medicine specialist at Hudson Medical, common risk factors include:

  • Age
  • Being overweight or obese
  • Having certain conditions like diabetes, gout, psoriasis, tuberculosis, irritable bowel syndrome (IBS), and Lyme disease

How Do Doctors Diagnose Spondylosis?

To diagnose spinal osteoarthritis, a doctor will need to conduct a physical and neurological examination — and look closely at a patient's spine and range of motion when bending forward, backward, and side-to-side. The physician will note the shape of the spine, including any abnormal curvatures, and will palpate or feel the spine to detect any tender spots, muscle tightness, spasms, bumps, or areas of inflammation.

Your physician will evaluate your pain level, along with other symptoms such as weakness or paresthesias, and take X-rays to detect bone spurs or loss of disc height, which can be a sign of degenerative disc disease. Your doctor may also order a CT (computerized tomography) or MRI (magnetic resonance imaging) to view degenerative changes and abnormalities in the spine’s soft tissues. Depending on your symptoms, you may undergo other diagnostic tests.

Spondylosis diagnosis imagingX-rays can show bone spurs, while other types of imaging can depict soft tissue changes.What Are Some Common Nonoperative Spondylosis Treatment Options?

“Spondylosis is treated with a multi-modal therapeutic approach, which best addresses the multi-faceted nature of the disease,” said Dr. LaSalle. "Physical therapy is a cornerstone of treatment in most cases, which helps to protect and strengthen the vulnerable areas of the spine. Complementary and alternative treatments such as massage and acupuncture can also be utilized as part of a holistic treatment approach."

The overall goal of nonoperative treatment is to improve the strength and coordination of the muscles that surround the spine so they can act like the world's greatest back and neck brace. Luckily, most patients respond favorably to nonsurgical treatments like anti-inflammatory medication, physical therapy, and injections.

  • Radiofrequency ablation of the nerves that innervate the painful and arthritic joints of the spine (usually facet joints) can provide pain relief for three to six months by stopping nerves from transmitting pain signals to the brain.
  • Strengthening exercises can help improve spinal flexibility, build strength, and endurance.
  • No-impact aerobic exercie improves overall circulation, resting muscle tone (which leads to better posture), and decreases inflammation

What Are Common Surgery Options for Spondylosis?

If you are diagnosed with spondylosis, we want you to know that spine surgery is seldom needed to treat spinal osteoarthritis that develops in the neck or back. However, in some cases, spondylosis symptoms can become progressively worse to the point that first-line therapies and middle-of-the-road treatments do not provide adequate pain or symptom relief.

Dr. Woods shared that “common reasons for surgery include nerve or spinal cord compression, which, if it becomes severe, can lead to significant arm or leg weakness and numbness. In some of these cases, back or neck surgery may be recommended.”

Surgery for spondylosis has two main components—removing what is causing pain and fusing the spine to control movement—and are respectively known as decompression and stabilization surgery.

Dr. Woods added, "if there is mechanical instability or misalignment due to the degenerative changes, surgery may be indicated.” He emphasized that the goal of surgery for spondylosis is to remove pressure from the nerves or spinal cord, which can be accomplished in several ways, but most commonly looks to remove bone spurs or herniated discs.

Some of the more common surgical interventions for spondylosis include:

  • Decompression surgeries to remove bones spurs (foraminotomy), herniated discs (discectomy), or part of the vertebra (facetectomy)
  • Stabilization surgery like spinal fusion to stabilize vertebral segments using bone graft and hardware if they are moving abnormally.
  • In some patients, disc replacement may be a good option, especially if you want to avoid fusion and spare motion.

Often, a decompression and fusion are done simultaneously. If a spinal surgical procedure is being considered, your doctor will look at many different factors, like your overall health,  to evaluate if you are a good candidate for surgery and decide on the best type of surgery for your situation.

What Are Some Complementary and Alternative Treatment Options for Spondylosis?

"While generally lacking robust clinical studies to support their efficacy, many complementary and alternative treatments have been used effectively to relieve pain related to spondylosis and degenerative conditions of the spine," shared Dr. LaSalle.  Some of these treatments include chiropractic manipulation, massage therapy, hypnotherapy, cryotherapy, and psychological interventions such as cognitive-behavioral therapy and biofeedback.  

Newer treatments include platelet-rich plasma (PRP) injections, stem cell injections, and laser endoscopic annuloplasty surgery. However, these treatments need to be studied more before they're adopted into widespread use. They're also not typically covered by insurance, meaning the whole cost will be on you to pay. Proceed with caution. 

One of the safest and viable treatment options for anyone suffering from spondylosis is acupuncture. "While high-quality clinical trials have not definitively shown a benefit, copious anecdotal reports and case series have demonstrated positive clinical outcomes, which given its low-risk profile, render it an intervention worth considering as part of a multi-modal treatment approach for degenerative conditions of the spine," added Dr. LaSalle. "Potential therapeutic mechanisms include modulation of local blood flow and modulation of the body's endogenous opioid and analgesic mechanisms."

spondylosis treatment acupunctureAcupuncture is an effective complementary and alternative treatment for many people with spondylosis.What Lifestyle Changes Can Help Prevent Spondylosis?

“Osteoarthritis, spondylosis, and softening happen to us all as we age,” commented Dr. Woods, “but being active and living a healthy lifestyle can help slow the onset of them or make them less severe.” You know what that means because you’ve read it a million times, but we’ll say it again: eat a balanced diet and do regular physical activity to maintain a healthy weight. Dr. Woods added that “there is some solid data which supports that an anti-inflammatory diet might decrease pain.”

Dr. LaSalle advises that “ reducing emotional and physical stress through mindfulness and stress-reduction strategies" is key to mitigating or preventing spondylosis. Smoking? Stop. Seriously.

Finally, you need to keep your mind right. Part of that is being proactive with your treatment strategies. If you’re not doing much besides watching your condition degenerate, that takes both a physical and emotional toll, which can accelerate your disease. It’s a feedback loop: Your back hurts, your feel lousy, you get stressed and depressed, your back hurts more, et cetera, et cetera, et cetera.

Luckily, though, the reverse is also true. When you’re taking charge of your treatment and it’s starting to take some of your pain away—or you’re proactively ruling out ineffective treatment strategies and trying new therapies—your body and your mind benefit. You have more physical and mental resources to put toward your recovery, so your back feels better and you feel less stressed and more hopeful.  

Bottom line: You got this!



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Updated on: 03/30/21
Choll W. Kim, MD, PhD
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