Spondylosis: All you need to know

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The spine helps give the body structure and supports most of its weight. It also carries and protects almost all of the main nerve branches that run from the brain.

The spine curved, not straight, and the cervical, thoracic, and lumbar parts of the spine contain 24 bones known as vertebrae.

Between these vertebrae are joints that allow the spine to move flexibly. These are called the facet joints.

Also, soft, rubbery tissue called intervertebral discs separate the vertebrae. These consist of cartilage endplates and a tough exterior, the annulus fibrosus, surrounding an inner core, the nucleus pulposus.

Intervertebral discs help achieve smooth movement, and they cushion against any impact on the bones.

As a person ages, the discs become drier, thinner, and harder, and they lose some of their cushioning ability. This is why an older person is more likely to have a compression fracture of the vertebra than a younger person.

A vertebral compression fracture results from bone collapsing in the spine. It commonly occurs with osteoporosis.

The facet joints between the vertebrae also function less well with age because of wear and tear on their cartilage surfaces.

As the cartilage erodes, the bones start to rub together, causing friction. This can result in the formation of bony growths, called bone spurs.

The loss of rubbery tissues and the development of spurs make the spine stiffer. Back movement also becomes less smooth, and friction increases.

Daily wear and tear over time is the general cause of spondylosis.

These changes affect people differently, depending on each individual’s risk factors.

Risk factors include:

• having a genetic tendency
• having obesity or being overweight
• having a sedentary lifestyle with a lack of exercise
• having injured the spine or undergone spinal surgery
• smoking
• having a job that requires repetitive or weight-bearing movements that involve the spine
• having a mental health condition, such as anxiety or depression
• having psoriatic arthritis

Most people with age-related spondylosis do not experience any symptoms. Some people have symptoms for a while, but then they go away. Sometimes, a sudden movement can trigger symptoms.

Common symptoms are stiffness and mild pain that gets worse following certain movements or long periods without moving, while sitting for a long time, for example.

More severe symptoms include:

• a grinding or popping feeling when moving the spine
• weakness in the hands or legs
• poor coordination
• muscle spasms and pain
• headaches
• loss of balance and difficulty walking
• loss of bladder or bowel control

Some initial changes or symptoms help doctors determine what type of spondylosis a person has. In other people, these same issues can develop as complications, according to research published in the BMJ in 2007.

Below, find examples of these kinds of changes:

Spinal stenosis: This is a narrowing of the canal that carries the spinal cord nerves. Symptoms include pain in the neck or back that may extend down the leg, problems with the feet, and numbness or weakness.

Cervical radiculopathy: Changes in a disc or the bone can cause nerves in the spine to become pinched, leading to shooting pain, numbness, and hypersensitivity.

Cervical spondylotic myelopathy: This involves the spinal cord becoming compressed, or squeezed. Symptoms include pain and numbness in the limbs, a loss of coordination in the hands, imbalance and difficulty walking, and in the later stages, bladder problems.

Scoliosis: Research suggests that there may be a link between degeneration of the facet joints and scoliosis in adults.

These changes can make other symptoms worse. The location of symptoms such as pain will depend on the part of the spine that spondylosis affects.

Most cases of spondylosis produce only mild, occasional stiffness and pain, and they do not need treatment.

Home remedies

If a person experiences pain, they can try the following:

• Over-the-counter pain relief medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help.
• Keeping physically active: Low-impact exercise, such as swimming or walking, can help with maintaining flexibility and strengthening the muscles that support the spine.
• Improving posture: Slouching, for example, can make the pain worse.
• Physical therapy: A physical therapist may suggest specific exercises or massage.
• Back support: A person may need to choose a chair or mattress that supports their back better.
• Rest during periods of inflammation: When symptoms are troublesome, try resting for a while.

Alternative treatments

Some people use the following to manage symptoms:

• acupuncture
• chiropractic treatment
• massage
• ultrasound treatment
• electrical stimulation

Research indicates that some of these may provide relief for nerve pain or damage that stems from the neck.

Medications

If pain is severe or persistent, a doctor may suggest:

• prescription pain relief medication
• muscle-relaxants, to reduce spasms
• drugs that ease nerve pain
• topical creams
• steroid medications, either in pills or as injections, when pain is severe
• an injection that combines steroid and anesthetic medication

A steroid injection aims to relieve pain by reducing inflammation. Using X-ray guidance, the doctor will inject the steroid into the roots of the affected nerves.

However, steroids can also have adverse effects, so a doctor will usually try to limit their use.

It is essential to follow the doctor’s advice when using medications.

A doctor will only suggest surgery if symptoms are severe and persistent and if no other treatment has helped.

A person might need surgery if pinched nerves result in serious numbness, weakness, or loss of bowel or bladder control, and if the damage is likely to get worse without surgery.

The type of surgery will depend on the problem and its location. A doctor can identify the affected areas with imaging technology, such as X-rays.

Surgery might involve removing a disc or piece of bone that is pressing against the nerves, then fusing nearby vertebrae. Or, a surgeon may replace a damaged disc with an artificial one.

In the past, spinal surgery was a major procedure. Now, endoscopic — or keyhole — surgery may be an option. This is far less invasive than open surgery.

According to the American Association of Neurological Surgeons, minimally invasive spinal surgery involves fewer risks, because:

• The incision is smaller.
• There is less blood loss during surgery.
• There is less chance of muscle damage.
• Recovery is faster.
• A doctor can use a local anesthetic.

Also, there is a reduced risk of pain and infection after surgery and less need for medication.

Minimally invasive spinal surgery is often an outpatient procedure, which means that many people return home the same day.

However, most people with spondylosis do not need surgery. A doctor will discuss the risks of spinal surgery, compared with the potential benefits.

Spondylosis is a common problem that affects the spine, and most people are likely to develop some degree of spondylosis as they get older. Many will not experience symptoms, or symptoms will be mild.

However, if pain is severe and numbness and weakness affect a person’s quality of life, a doctor may recommend surgery.