What is Spondylosis?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

In most cases, the term spondylosis refers to osteoarthritis that affects the spine, but it is also a term that can describe other conditions related to spinal degeneration. Cervical osteoarthritis causes changes to the joints of the neck, as well as the bones and the discs in between.

Sometimes, there is no outside cause for this; it is a natural occurrence of age as the spine slowly breaks down from every day use. The discs lose fluid, which cause them to become stiffer and more likely to crack and flake away. Cervical osteoarthritis is therefore most common in the elderly and the middle-aged.

Because osteoarthritis causes disc degeneration to increase, you may also develop abnormal growth like bone spurs or osteophytes on the bones in the cervical region. As the growths develop, the available room in the spinal column starts to narrow, which makes it more likely to develop pinched nerves. The osteophytes can also narrow where the spinal nerves exit to the rest of the body, which is a similar condition known as cervical spinal stenosis.

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More About Spondylosis

lumbar foraminotomyJust like with other spinal degeneration conditions, degeneration is more descriptive rather than a true diagnosis. It can simply refer to someone who suffers from degeneration of the spine and pain at the same time, even if the degeneration is located somewhere else and even if something else is causing the pain.

For example, facet joint osteoarthritis results in pain after extended inactivity or during high activity. Degenerative disc disease is when a dehydrated disc loses function, causing neck pain, lower back pain, and sometimes arm or leg pain. Spinal stenosis is an unusual narrowing of the canal that causes leg pain during activity.

Once the doctor has made a final diagnosis for what the problem is, rather than making a general description of the degeneration, then more specific terms will be used, such as osteoarthritis, cervical degenerative disc disease, cervical spinal stenosis, lumbar degenerative disc disease, or lumbar spinal stenosis. Using more specific terms will allow the doctor to work on a more appropriate treatment method for you.

Regardless of the specific term, aging is a huge factor when it comes to developing degeneration, which is why it is common to see in those over the age of 50. The discs between the vertebrae do not have the same spongy structure as earlier in life, which means they are not able to absorb as much of a shock in day to day life. Additionally, ligaments and bones both get thicker, which cause serious narrowing and a loss of space in the spinal canal.

Of course, injury to the neck or back can also cause degeneration in some cases, as can poor posture or a physically demanding career.

What Are the Symptoms?

In most cases, spondylosis does not present any symptoms. When symptoms do appear, they can generally be boiled down to stiffness in the neck and pain in the general area that may shoot out. In some cases, degeneration can result in the spinal cord’s housing narrowing, which encroaches on the nerves in the area.

If impingement occurs, then you may experience additional symptoms, such as tingling, a loss of bowel or bladder control, difficulty walking, and a lack of coordination.

Specific symptoms that may appear in those experiencing cervical degeneration include:

  • Headache starting in the neck
  • An inability to fully bend or turn the neck, which can interfere with driving
  • Pain in the arms or shoulder
  • Neck pain and stiffness
  • Grinding sensation or noise when turning the neck

In most cases, rest will improve the symptoms of spinal degeneration, though the pain is usually worst in the morning and then right before bed.

If the degeneration causes pressure onto the spinal cord, it can cause a condition that is known as cervical myelopathy. The symptoms of this secondary but serious condition are:

  • Abnormal reflexes
  • Lack of coordination
  • Difficulty with walking
  • Numbness in the legs and feet or arms and hands
  • Weakness in the legs and feet or arms and hands
  • Tingling in the legs and feet or arms and legs
  • A loss of control over the bladder or bowel

It is also possible for degeneration to cause a condition called cervical radiculopathy, which occurs after the growth of bone spurs applies pressure to the nerves exiting the spine. The most common symptom of radiculopathy is a shooting pain down at least one arm.

How is Spondylosis Diagnosed?

Symptom Assessment and Physical Examination:

To diagnose the condition, your doctor will start by writing down everything about your medical history and the symptoms you have experienced, if any. After this, he or she will exam the body, placing special focus on the shoulders, back, and neck. These physical exams will also probably include watching the way you walk, a test for loss of sensation, and checking the strength and reflexes of your arms and hands.

Diagnostic Imaging:

The MRI will be most helpful in producing images of the internal structures of your body, allowing the doctors to pinpoint the problematic areas causing pain. These scans create detailed images using radio waves, very large magnets, and a computer. Depending on the results of this test, you may also be sent to a neurologist for more testing.

Degeneration is usually a chronic condition, but it does not usually progress on its own, so you likely to not need to worry about undergoing surgery. In rare cases, surgery may be necessary to remove whatever is putting severe pressure on the nerves and spinal cord. In even rarer cases, this treatment method may also involve adding implants for improved stability, or fusing the vertebrae.

Of course, this is only necessary in the most severe cases when parts of the body are no longer functioning due to the nerve pressure. Remember, any kind of spinal cord compression can progress into a permanent disability.

What Are the Causes of Spondylosis?

low back pain

As you get older, the cartilage and bones in your neck and backbone naturally start to wear out and potentially develop tiny tears. Any little tear can progress into cracks and spinal degeneration. Some of the natural changes that can occur that lead to degeneration include:

  • Herniated discs: As we just mentioned, age will affect the otherwise tough exterior of the spinal discs. The tears can lead to cracks, which can lead to bulging or ruptured discs, and this can sometimes apply pressure to the nerve roots and the spinal cord.
  • Dehydrated discs: The discs contain water inside but gradually lose them over the years. By the time you reach the age of 40, your discs will start to shrink, allowing the vertebrae to grind on each other more often.
  • Bone spurs: Osteoarthritis typically results in the abnormal growth of extra bone as the body tries with futility to make the spine stronger. Unfortunately, these spurs can also pinch the nerve roots and spinal cord.
  • Stiff ligaments: The spinal ligaments naturally stiffen over age, which can make your neck feel stiff and inflexible. The ligaments are the tissues that connect the bones to one another.

How Is Spondylosis Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Spondylosis Pain Diagnosis and Treatment

Your doctor may order imaging tests to get a better idea of what is going on inside your spine, such as:

  • Neck x-ray: This helps reveal bone spurs and rules out fractures, infections, or tumors
  • CT scan: This test is like a more powerful x-ray, offering more detailed images of your bones
  • Myelography: This is just like a CT scan, except there is a contrasting dye injected into the spine
  • Electromyography: This tests how the nerves function as far as transmitting messages, which can help detect damage

How Does Spondylosis Compare to Other Spine Conditions?

Spinal degeneration could be mistaken for fibromyalgia syndrome, a fairly new diagnosis. Patients with FMS often receive a diagnosis for Lyme disease, depression, rheumatologic, spongyloarthopathy, and similar conditions before getting their diagnosis of FMS. Other symptoms of fibromyalgia include:

  • Widespread pain: With fibromyalgia, the pain doesn’t just stop near the spine; in fact, fibromylagia pain tends to be described as a persistent, widespread ache that lasts more than three months. To qualify as a widespread pain, you must feel it above and below the waist on both sides of your body.
  • Fatigue: Beyond the pain, there is also waking up tired despite long periods of sleep, which may be interrupted by flares of pain.
  • Cognitive issues: Difficulty concentrating.

Spinal degeneration refers to the natural breakdown of your spine’s anatomy, which occurs because of the natural dehydration of spinal discs over time. This causes the discs to become less elastic and unable to deal with every day movements the same as before. We have also described the symptoms above; if you are experiencing those symptoms, then it is wise to speak with your doctor about the potential for spinal degeneration.

Analogy: A Stick of Butter

Think of your spine as a stick of cold butter. It retains its strengths and holds its form and its goodness. Because spondylosis requires degeneration, it’s like a stick of butter that’s been left out in the heat too long. It begins to lose its shape and its content leak out.

Stick of Butter

Melted Butter

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