What Is Osteoarthritis?
What Is Osteoarthritis?
Osteoarthritis is also known as degenerative joint disease. It is a condition in which the protective cartilage that cushions the tops of bones degenerates, or wears down. This causes swelling and pain. It may also cause the development of osteophytes, or bone spurs.
What Is Osteoarthritis of the Spine?
Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back.
Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs.
Who Gets Osteoarthritis of the Spine?
In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes:
- injury or trauma to a joint
- a genetic defect involving cartilage
For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints.
What Are the Symptoms of Osteoarthritis of the Spine?
Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down.
Some people experience little interference with the activities of their lives. Others become more severely disabled.
In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.
How Is Osteoarthritis of the Spine Diagnosed?
The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.
The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:
- X-rays to look for bone damage, bone spurs, and loss of cartilage or disc; however, X-rays are not able to show early damage to cartilage.
- Blood tests to exclude other diseases
- Magnetic resonance imaging (MRI) to show possible damage to discs or narrowing of areas where spinal nerves exit
How Is Osteoarthritis of the Spine Treated?
In most cases, treatment of spinal osteoarthritis is geared toward relieving the symptoms of pain and increasing a person's ability to function. The goal is to have a healthy lifestyle.
Initial treatment may include losing weight if needed and then, for everyone, maintaining a healthy weight. It may also include exercise. Besides helping with weight management, exercise can also help:
- increase flexibility
- improve attitude and mood
- strengthen the heart
- improve blood flow
- make it easier to do daily tasks
Some of the exercises associated with osteoarthritis treatment include swimming, walking, and water aerobics. Exercise may be broken down into the following categories:
- Strengthening exercises.These exercises seek to make muscles that support the joints stronger. They work through resistance with the use of weights or rubber bands.
- Aerobic exercises.These are exercises that make the heart and circulatory system stronger.
- Range-of-motion exercises.These exercises increase the body’s flexibility.
Including rest periods in the overall treatment plan is necessary. But bed rest, splints, bracing, or traction for long periods of time is not recommended.
There are non-drug treatments available for osteoarthritis, including:
- heat or cold compresses, which refers to placing ice or heated compresses onto the affected joint (check with your doctor about which option, or which combination of heat and cold options, is best for you.)
- transcutaneous electrical nerve stimulation (TENS) using a small device that emits electrical pulses onto the affected area
- nutritional supplements
Pain medications may also be used to treat osteoarthritis. Over-the-counter products include acetaminophen (Tylenol).
Nonsteroidal anti-inflammatory drugs (NSAIDs) are also available over-the-counter in certain strengths. Examples include aspirin, naproxen sodium (Aleve), and ibuprofen (Motrin or Advil). NSAIDs uncommonly have serious side effects. Those include stomach irritation and bleeding, and less frequently, kidney damage.
Topical ointments and creams are also available to treat pain. They are applied to the skin in the area that hurts, but generally, these are not effective. Examples of topical drugs include Ben-Gay and Aspercreme.
Your doctor may also recommend prescription drugs to treat symptoms, as there are no medications that reverse the process. These may include prescription painkillers, mild narcotics, or injections of corticosteroids around the spinal column called epidural steroid injections. It is important to understand that these injections do not correct the underlying problem and are sometimes used without clear indication of long-term benefit. Oral steroids are not commonly used.
Most cases of spinal osteoarthritis can be treated without surgery, but surgery is sometimes performed. Spinal osteoarthritis is one of the causes of spinal stenosis, or narrowing of the spinal canal. In cases where bladder and bowel function is impaired, where the nervous system is damaged, or when walking becomes very difficult, surgery will likely be recommended.
Surgery for Spondylosis
Surgery for patients with chronic low back pain is controversial, because while some studies do show improvements in pain and disability, most studies do not show improvement as compared to nonsurgical treatment such as physical therapy and pain management. Also, many patients continue to have chronic back pain after the surgery.
Surgery is rarely necessary in patients with acute back pain, unless progressive neurologic problems develop. This is because most patients improve dramatically after treatment with medications and physical therapy, and most patients improve within days to weeks after back pain starts. Surgery is sometimes performed for acute sciatica, if nerve problems such as weakness and numbness are severe and worsen rather than improve, and cauda equina syndrome, a syndrome where the nerves at the bottom of the spinal cord are compressed by an intervertebral disc or a mass, causing neurologic problems.
Spinal decompression surgery is a general term used to describe various surgical procedures which are performed to relieve pressure on the nerves in the back due to spinal stenosis, herniated intervertebral discs, or foraminal stenosis (narrowing of the openings between the facet joints due to bone spurs).