Acute spondylosis: The request could not be satisfied
Aging is the predominant cause of spondylosis, also known as spinal arthritis. We put our bodies through a lot of stress and strain every day, and over the years, this can change the various structures of the spine. Even before you experience the symptoms of spondylosis—pain and stiffness, for example—your joints and other spine structures are degenerating (that means wearing out).
The main cause of spondylosis is aging, but the way aging affects your spine can lead to other changes and problems. Photo Source: 123RF.com.
Cause and Effect Scenario
You should think of the causes of spondylosis as a “cause and effect” scenario. The main cause is aging, but the way aging affects your spine can lead to other changes and problems. Spondylosis is a cascade: One anatomical change occurs, which leads to more degeneration and changes in your spine’s structures. These changes combine to cause spondylosis and its symptoms.
Degenerative Disc Disease
Generally, the first part of your spine to wear out are your intervertebral discs. For this reason, patients with spondylosis often also have degenerative disc disease (DDD). The effects of these 2 spinal conditions are very related.
The changes begin in your discs, but eventually the process of aging will affect the other motion segments of your vertebrae. (The discs and the facet joints are considered the motion segments, which means that they help you move.) Over time, the collagen (protein) structure of the annulus fibrosus (that’s the outer portion of the intervertebral disc) changes. Additionally, water-attracting molecules—and hence water—in the disc decreases. Both of these changes reduce the disc’s ability to handle back movement.
Through degeneration, the disc will become less spongy and much thinner. A thinner disc means that the space between the vertebra above and below the disc gets smaller, which causes a new problem, this time with the facet joints. They help stabilize the spine, and if the disc loses height, the way the facet joints move changes. Then the cartilage that protects the facets begins to wear away, perhaps causing irritation and inflammation of spinal nerve roots. Without the cartilage, the facet joints start to move too much: They “override” and become overly mobile.
Abnormal Spinal Movement
This hypermobility causes another change in your spine. It tries to stop the movement with the growth of small bony elements called bone spurs (osteophytes). Unfortunately, the bone spurs sometimes pinch nerve structures and cause pain. The bone spurs can narrow the space for the spinal cord and nerves—that disorder is called spinal stenosis. Degenerative disc disease won’t cause spinal stenosis in everyone, but it’s something you should be aware of if you have spondylosis.
Role of Genetics
Your genes can also cause spondylosis. You may be pre-disposed to excessive joint and disc wear and tear, so if someone in your family has or had spondylosis, you may also develop back or neck pain related to spondylosis.
Finally, the way you’re living could lead to spondylosis. Smoking, for example, adversely affects your discs and can cause them to degenerate faster. Smoking actually decreases the amount of water in your discs, and water is part of what helps your discs absorb movement. With less water content, your intervertebral discs can wear out sooner.
Spondylolysis | Johns Hopkins Medicine
What is spondylolysis?
Spondylolysis. Pars defect. Stress fracture. These three terms are used interchangeably, all referring to the same condition. Spondylolysis is a stress fracture through the pars interarticularis of the lumbar vertebrae. The pars interarticularis is a thin bone segment joining two vertebrae. It is the most likely area to be affected by repetitive stress. This condition is fairly common and is found in one out of every 20 people.
What are the symptoms of spondylolysis?
Spondylolysis doesn’t always have symptoms. When it does, the only symptom is usually back pain. The pain often gets worse with activity and sport, and is more notable when bending backward. Generally, the pain doesn’t interfere with everyday activities. If it persists, it is recommended to seek medical attention.
What are the risk factors for spondylolysis?
Being human and walking upright is the most basic risk factor for spondylolysis. The natural inward curvature of the lower back puts stress on the pars interarticularis. Certain sports that involve excessive or repetitive bending backward may increase the risk of spondylolysis. Examples include gymnastics, football and soccer. Young athletes may sometimes develop spondylolysis as a result of overuse and hyperextension of the lower back. Genetics could also be a risk factor for some people.;
If you have long-lasting, localized low-back pain, it could be due to spondylolysis. An X-ray is sometimes sufficient to defect a stress fracture. However, if pain persists despite rest and physical therapy, additional imaging may be necessary. Your doctor may need to order an MRI, a CT scan or a nuclear medicine bone scan with SPECT of the lumbar spine for a definitive diagnosis.
Spondylolysis treatment focuses on managing the pain and helping you return to your daily activities. This condition doesn’t typically put you at risk for spinal cord injury or nerve damage.
Depending on the degree of pain, treatment options include:
- Rest/break from sports
- Nonsteroidal anti-inflammatory drugs
- Physical therapy for muscle strengthening and general conditioning
- A lumbar brace
Surgery to repair the fracture is rarely needed, as the pain is expected to fade over time in most cases.
Surgery for Spondylolysis
Surgery may sometimes be an option for adolescents with lumbar spondylolysis. The fracture can be repaired by using a strong titanium screw. This surgery is done by making a 2- to 3-inch incision in the middle of the lower back. The screw is placed to secure the two sides of the fracture together, providing some compression across the area. Then a bone graft (a piece of bone from elsewhere in the body) could be used to further support the repair.
The surgery takes three hours, followed by two or three days in the hospital for recovery. Most adolescents will need to take two to four weeks out of school for recovery at home. Sports and rigorous exercises are restricted for three months after the surgery. This surgery is very successful in eliminating back pain related to spondylolysis. Most people are able to return to their previous level of sports and exercise without pain.
Your doctor may also recommend a surgical procedure such as spinal fusion if it’s found that spondylolysis has caused your vertebra to slip forward. This slippage is called spondylolisthesis, which is a different but related condition.
Spondylosis Wayne – Causes, Symptoms & Treatment of Spondylosis
As the body ages, it starts to experience wear and tear that doctors call degeneration. Spinal degeneration is a natural phenomenon that happens to everybody who lives long enough. Once a person reaches his or her 60th birthday, spinal degeneration is more common than not.
What causes spinal degeneration?
Spinal degeneration occurs because of biochemical changes in the tissues of the body. In the back, the discs or “cushions” that absorb shocks between vertebrae become weakened and flatten. The liquid in the disc that absorbs shock may lose its ability to rebound after pressure. The bones can become more brittle.
Spinal degeneration may also be caused by trauma (accident) or repetitive-stress injury.
What is spondylosis?
The spine is a column of bones (vertebrae) stacked one on top of the other. When the connections or joints between these vertebrae develop osteoarthritis, spondylosis can be diagnosed.
Spondylosis can be a confusing term, because some medical experts use it in a broad general way to refer to any type of back pain in an older person. The more accurate definition is that spondylosis is osteoarthritis of the spine. Another name for this condition is spinal osteoarthritis.
In some cases, bone spurs may develop on the vertebrae which, in turn, can put pressure on nearby nerves and cause pain, unusual sensations (tingling, loss of sensation, “pins and needles”) or weakness.
Spondylosis can occur anywhere in the back, including the neck area.
Things you should know about spondylosis
- Spondylosis in most patients cannot be prevented; there is nothing you did “wrong” that caused this problem.
- While most patients with spondylosis do not require surgery, many spondylosis patients will have long-term symptoms.
- Spondylosis symptoms cannot always be eliminated, but they can be managed.
Symptoms of spondylosis
Over time, spondylosis can result in nerve compression, that is, pressure on the nerve roots that can cause moderate to severe pain. Some common symptoms of spondylosis include:
- Stiffness, particularly in the morning
- Loss of sensation or abnormal sensations in the shoulders, arms, legs, feet
- Headaches at the back of the head
- Balance problems
- Loss of bladder or bowel control
Talking to University Spine Center about spondylosis
If you think you may have spondylosis, you may find it is a confusing subject to discuss. The spine experts at University Spine Center will help you diagnosis your condition and recommend appropriate treatment options. Be sure to find out if you have specific conditions (such as osteoarthritis or degenerative disc disorder) or any other related conditions (such as osteoporosis).
After a physical examination and medical history, you may be asked to undergo certain other diagnostic tests:
- CT scan or MRI scan
Spondylosis is usually treated conservatively, at least at first, since it often responds to such therapeutic options as:
Surgery is rarely a first-line approach to spondylosis but may be an appropriate treatment for some patients. This option should be discussed with your physician at University Spine Center.
What is Multilevel Spondylosis? | New Jersey Spine Specialists
Spondylosis, a common condition, is a general term for degeneration of the spine. Most doctors use this term to refer specifically to arthritis of the spine, or spinal osteoarthritis, an inflammation resulting from the age-related degeneration of the cartilage that cushions the joints. Spondylosis can affect more than one region of the spine. Lumbar spondylosis affects the lower back, thoracic spondylosis affects the middle region of the spine, and cervical spondylosis affects the neck area. Moreover, more than one segment, or level of the vertebrae in any of these regions can be involved. When multiple segments, or levels of the spine are involved, the condition is termed multilevel spondylosis.
Because it affects several vertebrae, multilevel spondylosis can be more severe than degeneration that affects only one. Spondylosis may result in restricted mobility and pressure on nerve roots and possibly on the spinal cord. This could lead to neck and/or low back pain, arm and leg pain, paresthesias (needles and pins), and muscle weakness. Pressure on the spinal cord can also lead to global weakness, loss of balance, difficulty with coordination, gait dysfunction, and loss or bladder and bowel control.
In most cases, spondylosis is the result of normal wear and tear of the spinal joints. As the body ages, intervertebral discs desiccate (lose water content) and become less elastic. Spinal ligaments begin to tighten, stiffen, and hypertrophy, and joints between the vertebrae begin to degenerate. Though degenerative spondylosis is almost always unavoidable, a healthy lifestyle may help to delay its onset. Genetics also plays a role in some cases, as spondylosis may be hereditary.
How Do Doctors Treat Multilevel Spondylosis?
Physical therapy and pain medication are often used to treat spondylosis symptoms, and in severe cases, spinal surgery is a potential spondylosis treatment option. Today in appropriately selected patients, minimally invasive surgery, such as endoscopic procedures and possibly even laser spinal surgery, may provide safe and effective alternative therapies for spondylosis and other spinal problems. Make sure your surgeon has experience with all standard and advanced techniques for treating spondylosis and other spinal conditions.
Ankylosing spondylitis | Symptoms, causes, treatments
Medical treatments can help control ankylosing spondylitis. And there are also many things you can do to help improve your symptoms.
Keeping active and paying attention to your posture can greatly help you minimise the long-term effects of this condition.
If you have ankylosing spondylitis, keeping active can really help you manage your condition.
Regular exercise is good for the range of movement of your back and to stop your spine from stiffening. Start slowly and gradually build up the amount of exercise you do.
Too much rest will increase the stiffening in your spine.
If you’re in a lot of pain and finding it difficult to exercise, talk to your doctor or a physiotherapist.
As well as being good for your back, exercise is important for your heart and lungs, and your overall health. It can also lift your mood and boost your confidence.
Specific simple exercises for your back, chest and limbs will help keep them supple. You may find stretching exercises after a hot shower or bath are especially helpful to ease stiffness in the morning.
Try to do at least some exercise each day. Remember you can take painkillers beforehand to help you exercise.
We have examples of exercises to help improve strength and flexibility. Try to do them every day.
Pilates, yoga and t’ai chi may be useful as these can help with posture, strength and flexibility. You can ask your physiotherapist for advice if you have any doubts or questions about a particular activity. If you go to a class, tell the instructor about your condition.
Swimming is one of the best forms of exercise because it uses lots of muscles and joints without jarring them. And the water supports the weight of your body. Swimming provides a great overall workout that improves your strength, stamina and flexibility.
Speak to your physiotherapist or a swimming instructor if you have discomfort when swimming, as a different stroke or slight change to your technique could help.
As an alternative to swimming, your local pool might run aerobic classes in shallow or deep water which you could try.
There are many types of exercise that will help maintain your mobility and improve your overall health. The key is to find something you enjoy as this will help you to keep doing it.
The National Ankylosing Spondylitis Society (NASS) offers regular exercise classes, run by physiotherapists, at various centres around the country. NASS can also provide information about gym-based exercise, an exercise DVD and mobile app.
Most people with ankylosing spondylitis can continue in their jobs. You may need some changes to your working environment or roles you carry out, especially if you have a physically demanding job.
Talking to people at your workplace about your condition is a good idea. This could be your line manager or human resources department. If your organisation has its own occupational health service, or can provide access to one, this could be a very useful avenue for you.
It would be a good idea to ask for a workplace assessment and tell the person carrying it out that you have ankylosing spondylitis.
Because of the Equality Act (2010), by law workplaces have to make sure that a condition such as ankylosing spondylitis doesn’t stop anyone being successful or comfortable at work.
Ankylosing spondylitis isn’t automatically covered under this law but it is if it affects your ability to carry out every-day tasks. This is based on how you would manage if you weren’t taking any medication. A good question to ask yourself therefore would be if you weren’t on any medication would you easily be able to do tasks such as getting dressed on your own?
Your employers may need to make some reasonable adjustments to your working environment to help you carry out your job. However, either you or they can apply to the government for funding for these adjustments under the Access to Work scheme.
Your employer might be able to provide flexible working, such as changing the hours you work or allowing you to work from home for at least some of the week.
It’s important to remember that you have rights and options.
Try to build short spells of exercise into your working day. Walking around and having a stretch at regular intervals will help you. Try not to stay in the same position for too long.
Sex, pregnancy and ankylosing spondylitis
Sex may be painful if you have ankylosing spondylitis. If it is, try taking some painkillers beforehand and experiment with different positions.
Ankylosing spondylitis can make you feel tired, so it’s important your partner understands how your condition affects you. Good communication can help you maintain an active sex life and counselling can sometimes benefit both partners.
It’s fine to use the contraceptive pill if you have ankylosing spondylitis, but you should tell your doctor you’re taking it.
If you’re thinking of starting a family, it’s very important for both men and women with ankylosing spondylitis to discuss medication with a doctor beforehand.
Some drugs such as methotrexate should be stopped several months before a woman tries to get pregnant. Latest research suggests it’s safe for men to take methotrexate when trying for a baby with their partner.
Biological therapies seem to be safe in the earlier stages of pregnancy but are then stopped later in pregnancy.
If you become pregnant while using a conventional DMARD such as methotrexate or a biological therapy, discuss this with your rheumatology team as soon as possible.
Usually, pregnancy doesn’t cause any special problems for the mother or baby, though the symptoms of ankylosing spondylitis may not ease during pregnancy. If your spine is very stiff, it may not be possible to have an epidural during childbirth. This is an injection into the back that stops people feeling pain in part of the body.
If your condition makes it difficult to open your legs, it’s a good idea to think ahead about the delivery and to discuss with the team at your antenatal appointments whether a Caesarean section might be better. This is an operation to deliver a baby through a cut made in a woman’s tummy and womb.
Will my children develop ankylosing spondylitis?
If you have ankylosing spondylitis, there’s a small chance your children will also develop it. The way it runs in families isn’t straightforward, so if you’re thinking of having a baby and are concerned about this, it’s a good idea to talk to your specialist.
Parents with ankylosing spondylitis sometimes ask if their children should have the HLA-B27 test to see whether they might develop the condition in the future. This isn’t recommended because there’s no way of knowing whether a child will develop ankylosing spondylitis even if they do have the gene.
Tiredness and night pain can affect people with ankylosing spondylitis. Good quality sleep can help you manage pain better.
There are many positive steps you can take to help you get good sleep. For example:
- having a warm bath before bed
- a hot water bottle or an electric blanket could also be soothing and provide some pain relief
- cutting out food and drinks with caffeine in, such as tea, coffee, cola, energy drinks and chocolate, from midday onwards. Avoid medicine with caffeine during this time too.
- getting into a good routine of going to bed at the same time each evening, and getting up at the same time each morning – even if your sleep was disturbed
- not sleeping during the day, as this can disturb your sleep pattern
- keeping your bedroom clean, tidy and uncluttered, and keeping your bedding clean – as this will help you relax more
- not watching TV, or looking at any type of electrical or computer screen for at least one hour before you go to bed
- not having a big meal in the two hours before you go to bed
- regular exercise, especially exercise that gets you at least a bit out of breath, can help you get good sleep. It’s best not to exercise within two hours of going to bed.
A medium-firm bed will be more comfortable than one that’s too soft, although the mattress should have some give in it so that it moulds to the shape of your spine.
Some people find memory foam mattresses, mattress toppers and pillows helpful to support their body, and in particular the spine.
Your head and neck should stay in line with the rest of your body when you’re in bed. Too many or not enough pillows could strain your neck.
Talk to your doctor if you continue to have problems sleeping.
Feet and footwear
People with ankylosing spondylitis may develop plantar fasciitis, a condition that causes pain in the heel or arch of the foot. If your feet are affected, you may benefit from custom-made insoles inside your shoes. These can also be called orthotics. Such insoles may help keep your lower limbs in the correct position, and relieve pain in your hips, pelvis or lower back.
A podiatrist is a trained foot specialist, who can assess and advise whether you need custom-made insoles. Sorbothane insoles or gel heel cushions can provide padding and may be enough to ease your discomfort. These can be found in your local chemist or sports shop.
In serious cases ankylosing spondylitis can affect your posture, or the position in which you hold your body. It may cause the spine to bend too much, and this can put extra strain on your spine.
Here are some tips for having a good posture:
- Relax your shoulders and keep them back, rather than hunched forward.
- Keep your chin up.
When sitting down:
- Don’t lean on your elbows.
- Hardback, upright chairs or straight-backed rocking chairs are better for your posture than low, soft, upholstered chairs or sofas.
- When sitting in an office chair, your buttocks should touch the back of your chair.
- Try using a cushion behind your lower back to give extra support or a custom-made lumbar support.
- When working at a computer desk or workstation, don’t stoop or stretch to reach things. Make sure everything you need is within easy reach.
- Make sure your seat is at the correct height.
- Keep your knees at right angles – get a foot rest if you need one.
- Don’t sit in one position for too long without moving your back.
If you can, try to lie on your back on the floor sometime during the day. This will help stretch out the front of your hips and improve your posture. You might like to use pillows to support your head, but try to keep the number of pillows to a minimum. Don’t place a pillow under your knees – stretching your knees out fully helps to maintain flexibility.
A physiotherapist can provide further advice and exercises to help with your posture.
Check your posture
You can check your posture by standing with your back against a flat wall within view of a full-size mirror.
Keep your heels, bottom and shoulders as close as you can to the wall. Hold this position for five seconds and then relax, try to do this three times in a row. Do this regularly, perhaps once a month, and record any differences you notice in the mirror. For example:
- How does your back look?
- Is there change to the natural curve of your spine?
- Can you keep your heels against the wall?
- Note the distance from the back of your head to the wall.
Report any changes you notice to your doctor. If you or someone else can take pictures of you doing this exercise it can help to monitor any change to your posture. Each picture must be taken from exactly the same position and angle every time. If you have difficulties with this exercise, seek advice from your physiotherapist or doctor.
Driving shouldn’t be a problem if you have ankylosing spondylitis, but there are a few points to bear in mind:
- On a long journey, stop from time to time at a safe place for five minutes and get out of the car for a stretch and quick walk around.
- If your neck or back is very stiff, reversing into parking spaces may be more difficult. Special mirrors and parking sensors can be fitted to help with this. You should inform the Driver & Vehicle Licensing Agency (DVLA) of your condition if you use fitted adaptations.
- If your neck is stiff, it will be more prone to injury. Make sure your headrest is correctly adjusted and that you keep your head back against it.
- If you can’t walk very far, you may be eligible for a Blue Badge, which entitles you to use disabled drivers’ parking spaces.
Your local council can give you information on the Blue Badge parking scheme. The National Ankylosing Spondylitis Society (NASS) can also provide guidance on this and about special mirrors.
Diet and nutrition
No particular foods have been found to make ankylosing spondylitis either better or worse.
However, eating a low-fat, healthy and balanced diet will help you stay a healthy weight for you and is also good for your heart and general health. Being overweight will increase the strain on your back and other joints.
Because ankylosing spondylitis can increase your risk of the condition osteoporosis, which makes bones thinner, it’s important you get enough calcium and vitamin D, to keep your bones healthy.
The best source of vitamin D is from sunshine on the skin. However, because we can’t guarantee sunshine all year round in the UK, it’s recommended we should all take vitamin D supplements daily in the autumn and winter months.
People at risk of not getting enough vitamin D from the sunshine are encouraged to take vitamin D supplements all year round. This includes people who:
- don’t spend much time outdoors
- wear clothes that cover all their skin
- have dark skin, as darker skin is not as good at absorbing vitamin D from sunshine.
Calcium is very important to make strong bones. The best forms of calcium are:
- dairy products such as milk, cheese and yoghurt – low-fat ones are best
- calcium-enriched milks made from soya, rice or oats
- fish that are eaten with the bones, such as tinned sardines.
Many diets have been recommended for people with ankylosing spondylitis, including avoiding certain food types. There’s no convincing evidence that these work, and there’s a chance you could miss out on essential nutrients. If you’re keen to try any of these diets it would be a good idea to discuss it with a dietitian or your doctor first.
If you have ankylosing spondylitis and you smoke, stopping smoking would be one of the best things you can do.
Having ankylosing spondylitis, or any kind of spondyloarthritis, can make you more at risk of having a heart attack or stroke. It can also cause problems with the lungs, as it can reduce movement of the joints in the chest.
Smoking is likely to put you more at risk of having a heart or lung problem, and of making them worse. Smoking can make other symptoms of ankylosing spondylitis worse too. There’s also evidence that it can reduce the effectiveness of treatments.
Smoking is more likely to cause the bones in the spine fuse together.
Stopping smoking can be difficult. However, with determination and persistence, you can succeed. Your doctor or rheumatology team will be able to help if you’re struggling to stop smoking. The NHS has information, advice and support online to help.
Generally speaking, complementary and alternative treatments are usually safe. However, you should always talk to your doctor before starting treatment, as there are some risks associated with specific therapies. It’s important to go to a legally registered therapist, or one with a set ethical code who is fully insured.
If you decide to try therapies or supplements, you should be critical of what they’re doing for you and base your decision to continue on whether you notice any improvement.
Acupuncture can help relieve pain but won’t have any effect on the way the condition progresses. Very fine needles are inserted at a number of sites around the body but not necessarily at the painful area. Pain relief is obtained by interfering with pain signals to the brain and by causing the release of natural painkillers, called endorphins. To be successful, you might need to have several sessions.
Spinal manipulation is not helpful or safe for people with ankylosing spondylitis as it could result in permanent damage to your spine or spinal cord. Manipulation is a type of manual therapy used to adjust parts of the body, joints and muscles to treat stiffness and deformity. It’s sometimes used in physiotherapy, chiropractic, osteopathy and orthopaedics.
Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment
Ankylosing spondylitis (AS) is a chronic inflammatory disease causing axial arthritis, frequently resulting in inflammatory low back pain early in the disease course, with eventual severe impairment of spinal mobility due to structural changes ultimately leading to spinal fusion. AS is the archetype of a heterogeneous group of arthritides within the rheumatic diseases known formerly as the seronegative spondyloarthropathies but now frequently referred to as spondyloarthritis (SpA). In addition to axial arthritis, AS can result in peripheral arthritis, enthesitis, and uveitis, all shared characteristics of the SpA.
Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. AS occurs more frequently in men than women (2:1). Age of disease onset usually peaks in the second and third decades of life. Approximately 80% of patients with AS experience symptoms at ≤ 30 years of age, while only 5% will present with symptoms at ≥ 45 years of age.
The precise etiology of AS remains mostly unknown, though heritability is frequently cited as a significant contributor. Major histocompatibility alleles, particularly HLA-B27, may account for up to one-third of the genetic effect. Other MHC alleles that may play a minor role in AS heritability include HLA-B60 and HLA-DR1. Recent genome wide association studies (GWAS) of patients with AS have identified susceptibility loci, including IL23R, ERAP1, and IL1R2 among others.
Most patients with AS will experience symptoms of inflammatory back pain due to sacroiliitis and axial arthritis of the spine. This will frequently be accompanied by peripheral arthritis, enthesitis, and/or acute anterior uveitis. Cardiac involvement resulting in aortitis and arrhythmias occur less commonly.
Spinal inflammation results in symptoms of back stiffness, soreness, and pain. Symptoms tend to worsen in the early morning hours, causing sleep disturbance in many patients. Inflammatory back pain will tend to improve with stretching and physical activity and worsen with prolonged inactivity.
The natural history of AS for some patients includes structural abnormalities of the spine from development of new bone formation. These syndesmophytes frequently bridge adjacent vertebrae, resulting in impaired spinal mobility. This process tends to be slow, but when it progresses can ultimately lead to complete spinal fusion or ankylosis (i.e. the so-called “bamboo spine”). For many patients, ankylosis classically begins at the sacroiliac joints and progresses in an ascending manner, from the lumbar spine to eventually the cervical spine. Based on more recent data, the pattern of spinal fusion may actually occur in a saltatory manner rather than strictly in continuously ascending fashion.
There is no consensus on the diagnosis of AS, but the 1984 Modified New York classification criteria has been generally accepted for both research and clinical purposes. It requires at least 1 clinical manifestation and at least 1 radiographic parameter. Clinical manifestations include ≥ 3 months of inflammatory back pain that improves with exercise and exacerbated by rest, limitation of lumbar motion in both frontal and sagittal planes, and limitation of chest expansion compared to the normative population. Radiographic parameters include ≥ grade 2 sacroiliitis bilaterally or grade 3 or 4 sacroiliitis unilaterally.
Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA. These recent criteria may aid clinicians in the diagnosis of axial SpA well before patients fulfill AS criteria by the 1984 Modified New York criteria.
The ASAS criteria for axial SpA mandates patients have back pain for ≥ 3 months and be < 45 years of age while fulfilling 1 of the following 2 sets of criteria:
- Sacroiliitis on imaging* and ≥ 1 SpA feature**
- HLA-B27 and ≥ 2 SpA features**,
*Sacroiliitis on imaging is based on active inflammation on MRI highly suggestive of sacroiliitis associated with SpA, or on definite sacroiliitis based on the 1984 Modified New York Criteria.
**SpA features include inflammatory back pain, arthritis, enthesitis, uveitis, dactylitis, psoriasis, Crohn’s disease/ulcerative colitis, good response to NSAIDs, family history of SpA, HLA-B27, and elevated CRP.
Depending on whether symptoms include axial arthritis, peripheral arthritis, or enthesitis, effective treatment modalities will vary. All patients with AS should undergo physical therapy to improve spinal mobility and physical functioning. Non-steroidal anti-inflammatory drugs (NSAIDs) are nearly always used in conjunction with physical therapy to alleviate symptoms of inflammatory back pain. Any NSAID will usually be effective, when used at near maximum recommended doses; however, indomethacin has been considered the NSAID of choice based mostly on anecdotal evidence. If NSAIDs fail to improve symptoms of sacro-iliitis, intra-articular corticosteroid injections of the sacroiliiac joints may be considered. The introduction of TNF inhibitors, including etanercept, infliximab, adalimumab, and golimumab, have contributed further to alleviating the symptoms of axial arthritis. Based on data from clinical trials, patients with active AS reported not only reduced inflammatory back pain but improved physical functioning, fatigue, and quality of life. As is true for all treatment modalities for AS, TNF inhibitors have not been demonstrated to slow the disease progression of patients with AS destined to incur spinal fusion.
For symptoms of peripheral arthritis, the disease-modifying antirheumatic drugs (DMARDs) including sulfasalazine and methotrexate are frequently effective and well-tolerated. Leflunomide has not demonstrated to be that effective in AS, unlike rheumatoid arthritis and psoriatic arthritis.
The prognosis for many patients with AS will be complete spinal ankylosis, while others will experience intermittent flares between bouts of clinical remission. The long-term goal in the treatment of AS is to preserve as much physical functioning, decrease work absenteeism, and maintain a high quality of life.
- Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007;369(9570):1379-90.
- Reveille JD. Epidemiology of spondyloarthritis in North America. Am J Med Sci 2011;341(4):284-6.
- Dillon CF, Hirsch R. The United States National Health and Nutrition Examination Surveyand the epidemiology of ankylosing spondylitis. Am J Med Sci 2011;341(4):281-3.
- Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68(6):777-83.
Spondylolysis & Spondylolisthesis – USC Spine Center
Spondylolysis is the medical term for a spine fracture or defect that occurs at the region of the pars interarticularis. The pars interarticularis is region between the facet joints of the spine, and more specifically the junction of the superior facet and the lamina.
Spondylolisthesis is the medical term used to describe the forward slippage (anterior translation or displacement) of one spine bone (vertebrae) on another.
Quite often, a person who has spondylolysis (pars fracture) will also have some degree of spondylolisthesis (forward slippage of one spine bone on another). However, a person may have a spondylolysis without having spondylolisthesis, and a person may have spondylolisthesis without having a spondylolysis.
It is more common for a child or young adult to have a spondylolysis (pars fracture) without having spondylolisthesis, whereas adults are frequently diagnosed with spondylolisthesis without spondylolysis. Although it is confusing, both of these conditions are frequently seen in combination, and the treatments for both conditions are often the same. However, it is much more common for adults to be treated surgically; children with spondylolysis/spondylolisthesis rarely require surgery unless the slippage is severe.
There are a number of causes of spondylolisthesis, and a classification system was developed by Wiltse. There are six types (or causes): Type I is congenital (birth defect) or dysplastic (developed abnormally early in life), Type II is isthmic (caused by a pars fracture and instability), Type III is degenerative (caused by arthritis), Type IV is traumatic (acute facet fracture/injury to the facet complex), Type V is pathologic (caused by a tumor, cancer, or infection), and Type IV is postsurgical (iatrogenic bone removal).
Back pain is the most common presenting symptom, particularly in adults. Children may or may not have significant back pain; the predominant symptom(s) may be difficulty walking, postural deformity, and/or hamstring tightness. Adults frequently have leg pain, numbness, and/or weakness (sciatica, radiculitis, or radiculopathy) while children rarely have leg symptoms.
Children with spondylolysis and spondylolisthesis often have a stiff-legged gait and backward pelvic tilt, causing the buttocks to appear very flat. If the spondylolisthesis is severe, a “step-off” may be felt over the lower back region. The hamstring tightness may be so severe in some children that forward bending is limited and picking something off the floor is impossible. The neurological examination of strength, sensation, and reflexes is usually always normal in children.
Adults with spondylolysis and/or spondylolisthesis frequently have lumber tenderness and an antalgic gait (pain causing abnormal walking), but rarely have a noticeable deformity unless the slippage is severe or has been present since childhood. Adults may have numbness, weakness, and/or neurogenic claudication, especially if the associated arthritis and spinal stenosis is severe.
Spondylolysis and spondylolisthesis is frequently identified with regular lumbar x-rays, especially the lateral (side view) x-rays. It is sometimes difficult to see a non-displaced or minimally displaced pars fracture (spondylolysis), therefore oblique and flexion/extension x-rays are usually obtained. A Computed Tomography (CT) scan is the best test to verify that a pars defect/fracture is or is not present. The amount of forward translation (spondylolisthesis) is quantified by evaluating the percentage of slippage of one bone on another. The Meyerding classification is used determine whether it is a Grade I (0-25%), Grade II (25-50%), Grade III (50-75%), Grade IV (75-100%), or Grade V (more than 100%). The slip angle is determined by how angulated the L5 bone is on S1.
An MRI test is useful to evaluate the severity of nerve compression, but is less accurate at detecting a pars fracture than a CT scan. A bone scan may be ordered to determine if the spondylolysis pars fracture is recent (acute), or if it is old (chronic). A recent fracture would generally have a significant radionucleotide uptake and appear as a “hot spot” in the lower lumbar region.
There are no laboratory tests used to diagnose spondylolysis or spondylolisthesis. Occasionally, specific tests are ordered to rule out infection or other medical/rheumatologic conditions.
A discogram may useful in an adult patient to determine if the discs adjacent to the spondylolysis/spondylolisthesis are also causing pain. A doctor performs this procedure by injecting radiopaque dye, under pressure, into the discs of the lumbar spine. The procedure is performed using fluoroscopy, a special x-ray machine that allows x-ray images to be viewed instantly on a television monitor. A discogram would not be recommended for an adolescent or child.
If a patient has significant leg pain, weakness, and/or numbness, electromyography and nerve conduction velocity (EMG/NCV) tests may be recommended. EMG/NCV tests are useful to determine which nerve is affected, and how severely it is damaged or irritated. The test will often clarify where a nerve is actually being compressed – whether it is in the back, buttock, or leg.
The diagnosis of spondylolysis and/or spondylolisthesis may be suspected, particularly if the above-mentioned physical findings are present. An x-ray or CT scan is required to confirm the diagnosis, as well as to grade the severity of the condition.
The treatment of adult patients with spondylolysis and/or spondylolisthesis depends on the severity of the pain, nerve compression, and slippage. Nearly all patients are recommended for conservative treatment initially unless there is a severe neurologic deficit such as leg weakness and numbness. Physical therapy, chiropractic care and oral medications (non-steroidal anti-inflammatory medications, pain medications, and muscle relaxant medications) are frequently prescribed. Epidural steroid injections and/or nerve root blocks may also be utilized for severe pain or moderate pain that is no longer responding to other conservative measures. Patients who fail these conservative measures are usually candidates for surgical intervention.
The recommended surgery for adults with spondylolysis and/or spondylolisthesis who have failed nonoperative measures is spinal fusion. The goal of surgery is to stabilize the levels of the spine that are “slipping” by placing bone graft and metal rods/screws (instrumentation). Adult patients with significant stenosis (narrowing of the spinal canal due to bone spurs) generally require laminectomy and decompression, whereas children do not. The instrumentation fixes and holds the bones in place immediately, while the bone graft fuses (mends) the unstable spine bones together. After the fusion surgery is performed, it takes approximately 4-8 months for the fusion to “take” and the bones to solidly mend together. Prior to using metal instrumentation, patients were often required to be placed in body cast for 8 months to help the fusion mend. Nowadays, most patients are recommended to wear only a small plastic brace or soft corset, if anything, for 2-3 months after surgery to help the fusion solidify. The success rate for patients undergoing surgery is very high, and there are new minimally invasive surgery techniques that have been developed to allow patients to have an even faster recovery.
Boxall D, Bradford DS, Winter RB, Moe JH: Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 1979;61:479.
Carragee EJ: Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults: a prospective randomized study. J Bone Joint Surg Am 1997;79:1175.
Deguchi M, Rapoff AJ, Zdeblick TA: Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. J Spinal Disord 1998;11:459.
Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP: The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984;66:699.
Hensinger RN: Current concepts review: spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg Am 1989;71:1098.
Peek RD, Wiltse L, Reynolds, JB et al: Arthrodesis without decompression for grade III and IV isthmic spondylolisthesis in adults who have severe sciatica. J Bone Joint Surg Am 1989; 81:62.
Ricciardi JE, Pflueger PC, Isaza JE, Whitecloud TS: Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. Spine 1995;20:1917.
90,000 Symptoms and treatment of spondylosis of the lumbar spine
The term spondylosis in medicine is a degenerative process in the spine, leading to the formation of bone growths along the edges of the vertebral bodies. You can literally see the processes occurring in the vertebral body on an X-ray. The X-ray image shows distinct contours of the vertebrae and pronounced bone formations of various shapes – osteophytes. Osteophytes are the hallmark of spondylosis .If the growth of osteophytes is not interrupted, the process ends with the fusion of two vertebrae together. Depending on the location of spondylosis is called the corresponding anatomical structures of the spine: spondylosis of the cervical spine, spondylosis of the thoracic spine, spondylosis of the lumbar spine . Spondylosis of the cervical spine occurs more often in people of intellectual work – this is due to a long, monotonous, sitting position due to which the cervical spine experiences prolonged stress. Spondylosis of the lumbar spine is diagnosed mainly in people of physical labor. In most cases, at the initial stage , spondylosis is asymptomatic and reveals itself only during examination on suspicion of other diseases: osteochondrosis, disc protrusion, disc herniation, etc. The prevalence of spondylosis among the population is not uniform. Predominantly spondylosis affects 90,004 people over middle age. Possible clinical manifestations of spondylosis among young people, as a rule, this is facilitated by a pathologically curved posture.An important place in the prevention and treatment of spondylosis of the spine is occupied by therapeutic exercises, therapeutic massage, the development of a culture of movement and compliance with safety measures when working with weights.
Symptoms characteristic of spondylosis
Back pain with spondylosis does not have a pronounced acute or shooting character. Back pain may be completely absent. Most often, patients complain of a feeling of stiffness in the back, a feeling of fatigue in the neck, lower back, aching pains that disappear when kneading the affected area.There is also a meteorological dependence of the area affected by spondylosis. For these reasons, spondylosis can be detected only after a thorough neurological examination using methods of radiation diagnostics: radiography, magnetic resonance imaging.
Why does spondylosis occur?
There is no consensus on the causes of spondylosis among specialists: surgeons, orthopedists, neurologists. But the main thing can still be highlighted. The onset of spondylosis is largely promoted by a sedentary lifestyle, or, as we often hear now, physical inactivity.One-time physical activity against the background of physical inactivity (mainly seasonal trips to the country, as well as seasonal trips to fitness centers and sports sections) lead to microtrauma of the ligamentous apparatus of the spine, which entails a reaction of replacing injured ligaments with bone tissue and the development of spondylosis
In whom and how can spondylosis be detected?
The majority of the able-bodied male population employed both in physical work and in the field of knowledge workers is considered to be at risk for the manifestation of symptoms of spondylosis.Of course, spondylosis also occurs in women with the same distribution of symptoms by type of work activity, but nevertheless, the ratio of the number of patients with spondylosis to the total mass of healthy people is clearly not on the side of men. Early diagnosis of the disease allows timely initiation of treatment for spondylosis of the entire spine, as well as of the lumbar spine, and to protect oneself from the transition of spondylosis; to a chronic form, and also not to wait for the moment when only radical methods of surgery will be effective treatment.To diagnose spondylosis, you just need to take an X-ray of the spine. In case of detection of osteophytes, the main signs of spondylosis, we recommend to undergo an additional examination on a magnetic resonance imaging (MRI) scanner, which will allow you to see what X-ray diagnostics cannot show. MRI clearly demonstrates the condition of the spinal ligaments and the condition of the intervertebral disc. Since in spondylosis the ligaments are at the first line of contact with osteophytes, monitoring their condition will avoid such a dangerous complication of spondylosis as a herniated disc of the spine.
We use time-tested natural methods of restoring the body for various pathologies of the spine. In the treatment of spondylosis of the spine, the use of hirudotherapy (treatment with leeches), homeopathic preparations from Hell (Germany), safe apparatus traction of the spine, a rich arsenal of techniques for gentle manual effects on the spine and, of course, therapeutic gymnastics have proven themselves well.
Before touching on the topic of treatment, it is necessary to point out that treatment does not mean the elimination of the symptoms of back pain and the external manifestations of the disease, namely, therapeutic measures that contribute to the elimination of the causes leading to the pathology of the spine and back pain of a chronic or acute nature.Pharmacological / medicinal help for back pain justifies itself only at the initial stage of the acute course of the disease, when all drugs are good for quickly relieving an acute pain attack in the lumbar or any other area of the back and ridding a person of fear. After all, fear is a sufficient irritant of the central nervous system, multiplying the perception of pain. In cases of acute back pain, the use of drugs is 100% justified. Since such conditions are rare in spondylosis, the use of anesthetic and anti-inflammatory drugs of artificial origin in this disease is considered undesirable.Any chemical product / medicine has a harsh effect on the general physicochemical balance of the body, to which your attention is drawn in the annotation to medicines in the sections: contraindications / complications. Do not test your body for strength. He needs your help, not shock therapy, “deafening” the nervous system with or without reason. Refrain from unreasonable use in the treatment of drugs of a chemical nature. Never self-medicate, be sure to visit a specialized specialist in person.The consequences of inappropriate drug use can be severe or irreversible.
You can make an appointment with the head physician of our clinic’s vertebro-neurologist by calling 8 (903) 722-62-21, 8 (499) 610-02-10 or by leaving a request on our website.
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90,000 Doctors who treat spondylosis of the thoracic spine in St. Petersburg: reviews, doctors and clinics
Vertebrologists of St. Petersburg – latest reviews
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Show 10 reviews of 946 90,000 Spondylosis of the lumbar spine – signs, diagnosis and treatment
One of the most formidable complications in the presence of problems with the ridge is spondylosis.You should find out what the diagnosis of lumbar spondylosis is fraught with for the patient, how the pathology is detected and how it is treated.
How does spondylosis of the lumbar spine arise
Spondylosis deformans has classic symptoms similar to trauma, osteochondrosis and herniated intervertebral discs. If there is damage to the nerve endings of the spinal column, problems arise with the limbs and correct movements. It is important to identify the pathology in the early stages so that there is an effect of conservative treatment and there is no damage to the spinal cord.Spondylosis is associated with degenerative changes in the intervertebral discs. When the connective tissue weakens, thinning of the ligamentous apparatus occurs. As a result, there is an increased risk of injury.
In the place of damage, osteophytes form over time – bone growths, which gradually grow inside the fibrous ring of the articular discs and in the thickness of the intervertebral ligaments. The most common spondylosis of the lumbosacral spine. Due to the proliferation of osteophytes, the articular processes cannot cope with the task of shock absorption, which leads to severe pain.Also, the appearance of pathology is significantly influenced by the patient’s lifestyle.
Causes of spondylosis
The main provoking factor is premature aging and deterioration of the patient’s body. With age, destructive processes occur in the skeletal system associated with wear and thinning of cartilage, resorption of bone mass. If there are unfavorable factors at an early age, then the pathology develops in adulthood.
What influences the onset of the disease:
- Previous injuries and bruises.Not in all situations, an injury to ligaments or tendons leads to bone growths of osteophytes, but it can become a trigger for the appearance of a destructive and pathological process. Usually, after injuries suffered in adolescence, spondylosis occurs at an older age.
- Physical effort associated with professional sports. Athletes who lift weights are most prone to spinal diseases, including spondylosis.
- Incorrect posture. Due to the skew in the spine, an incorrect distribution of weight over the body occurs, due to which some muscle groups are severely overloaded, while others do not receive the load.As a result, over time, trophic tissue disorders appear, the quality of recovery decreases and a degenerative complication appears – spondylosis.
- Age-related degenerative changes. After 40 – 50, the elasticity of the connective tissues gradually decreases, and the strength of the bone tissue decreases. If microtrauma and damage occur, then osteophytes are replaced, which subsequently grow strongly.
- Hormonal disorders. During the period of female menopause, there is a persistent lack of estrogen, due to which the bone tissue becomes weak.When men go into andropause and testosterone levels become low, similar changes occur, which negatively affect bone strength.
- Hereditary factor. It has been proven that if close relatives suffered from spondylosis, then the likelihood of the disease in children is increased.
- The presence of congenital malformations of the spine. If the patient has a tropism anomaly in the lower back, then in the future there is a risk of spondylosis.
- Infectious lesions.With chronically reduced immunity, persistent colds occur. If the disease is not completely cured, it can complicate the joints and bones. As a result, without the timely use of antibiotics, the patient develops spondylosis.
- Metabolic disorders. In the presence of metabolic syndrome, the risk of pathology is increased.
- Obesity. With increased body weight, there is increased pressure on the ligaments, muscles and joints, which leads to an overload of the spine.In particular, the problem is relevant if the muscle corset of an obese person is not developed. Persistent pain and impaired mobility occur.
- Presence of systemic autoimmune diseases. Such pathologies contribute to the appearance of spondylosis – diabetes mellitus, uncompensated hypothyroidism, atherosclerosis, adrenal pathology.
- Oncological diseases. The presence of a tumor process destructively affects the state of the patient’s body, including the spine.
According to doctors, the most predisposing disease on the way to spondylosis is osteochondrosis. This pathology is also associated with degenerative and dystrophic disorders in the structure of the intervertebral discs. The result is a softening of the bone structure and cartilage tissue, which further leads to serious complications, including spondylosis of the lumbar spine.
Classification and signs of spondylosis
To finally establish the diagnosis, you need to rely on the international classification of diseases.The lesion can affect any of the five vertebrae of the lumbosacral segment:
- L1-L2 – spondylosis of the first and second lumbar vertebra.
- L2-L3 – detection of pathology between the second and third lumbar vertebrae.
- Level L4 – L5.
- L5-S1 – lesion of the lumbosacral region.
The latter is the most common. The disease occurs in the presence of adverse factors, and includes vivid symptoms of manifestation.
Stages of the disease include:
- The development of the disease at the initial stage is practically not manifested in any way. In rare cases, with a heavy load on the spine, moderate pain in the lumbar region occurs. At the initial stage of the development of spondylosis, deformities are insignificant. It is possible to determine the pathology at the initial stage of development by chance. If you carry out a diagnostic study, you can notice on the images of the spine the beginning of the growth of bone growths on the affected areas of the discs.
- In the second degree, the pain becomes significant, stiffness is felt in the morning. The pain increases while standing and leaning forward, so prolonged static stress should be avoided. The signs of spondylosis are increasing. The pain changes the course. There is severe discomfort, characterized by a long duration.
- At the last stage, the onset of pain does not depend on provoking factors. There is numbness, paresthesia of the extremities, loss of sensation in the legs. The patient cannot perform the usual actions, motor skills are almost completely impaired, because osteophytes have grown greatly, due to which mobility is severely limited.Surgical elimination of pathology is required.
Common symptoms of spondylosis suggestive of disease include:
- Pain syndrome – aching and pulsating at the level of development of the lesion. There is no irradiation to other parts of the spine or internal organs. Usually, the discomfort is chilling in the morning and increases with bending, physical exertion. Warming up the muscles slightly and temporarily relieves the condition.
- Impaired mobility. The patient cannot bend in the back or bend over to the stop.When turning the body, a clear limitation of movement to the sides is felt.
- Lameness – signs of compression of the sciatic nerve fibers. Lameness first occurs during exercise, and later in a calm state.
- Loss of sensation in the lower extremities is a symptom associated with a pinched nerve root.
In a third of cases, the disease is asymptomatic, but less often only lameness is observed. With such meager symptomatic signs, pathology is already determined at a late stage, when the patient becomes really sick.In the later stages, stiffness appears in the spine, associated with the growth of osteophytes.
According to the severity of symptoms, several stages are observed:
- At the initial stage of spondylosis, signs of the disease are absent or mild.
- At the second stage of the development of pathology, there is a partial limitation of mobility. Numbness of the limbs is sometimes observed.
- The third stage is terminal. The patient has chronic back pain, movements are constrained. The patient is assigned a disability.
The sooner an unfavorable symptomatology occurs, the sooner you need to seek help from a specialist. At the initial stages of the development of the disease, it is still possible to cope with discomfort with the help of conservative therapy.
Diagnosis of spondylosis of the lumbar spine
If the patient has characteristic complaints, he should make an appointment with an orthopedic traumatologist. The specialist conducts a visual examination of the patient’s back and listens carefully to the complaints.To clarify the diagnosis, it is necessary to conduct a series of studies:
- Radiography. On the X-ray, you can see unfavorable pathological changes that can lead to spondylosis. An example is clearly visible instability of the spine, non-closure of the arches or spinous processes, anomalies of tropism.
- MRI. Magnetic resonance imaging can look at adverse soft tissue changes, including inflammation, trauma, and the presence of spondylosis. This is one of the most reliable methods for examining the tissues of the spine.
- CT – improved version of radiography. Suitable for those patients who cannot have magnetic resonance imaging. The type of study clearly distinguishes between hard tissues and without any problems will see osteophytes, imbalance of the spine.
- Laboratory analyzes. Some blood tests can identify markers of inflammation that indicate a rheumatoid course of the disease. The patient takes the CBC, ESR, C-peptide, rheumatic tests.
Based on the results of the examination, a diagnosis is made, after which a treatment regimen is prescribed.
Treatment of spondylosis of the lumbar spine
The treatment regimen depends on the stage of the disease. At the initial stages, conservative therapy is shown, aimed at improving the patient’s well-being. During an exacerbation, medications are prescribed to relieve pain and improve joint function. If large osteophytes are found, and there is no improvement from conservative treatment, then the problem is solved by a radical method – the growths that impair the mobility of the spine are excised.
Drug treatment of spondylosis of the spine
Conventionally, drugs can be divided into two types – supportive and symptomatic.In the first case, medications are prescribed in combination with conservative treatment when bone support is needed. These medicines are ineffective in the acute period, since they do not affect the mediators of inflammation and pain. Symptomatic treatment is aimed at normalizing the patient’s well-being in a short period.
In case of a painful attack, what medications are prescribed to alleviate the patient’s condition:
- Non-steroidal anti-inflammatory drugs. NSAIDs are the first line of choice, as they can easily relieve pain and reduce inflammation in the damaged area of the back.The drugs work quickly. Within a few hours after the injection or the taken pill, the patient feels significant relief. The duration of admission depends on the severity of the situation and should not exceed 2 – 5 days for non-selective NSAIDs and 3 weeks for drugs of a selective type of action. Examples of drugs of indiscriminate action – Ketorol, Diclofenac, Nalgezin. The priority is to use selective NSAIDs, which have a lower frequency of side effects – Movalis, Nimesil, Lornoxicam.
- Corticosteroids. These are systemic hormonal agents aimed at suppressing inflammation in soft tissues and reducing the immune effect. The use of these funds is relevant in two cases – the ineffectiveness of NSAIDs and the presence of rheumatological diseases. If pain relievers do not give the desired effect, then corticosteroids are used in the form of intra-articular injections. The procedure is called injection blockade. Under the control of an ultrasound probe, a glucocorticosteroid of prolonged action is injected into the affected area.Usually, one blockade is enough for the patient to experience long-term relief. An example of funds is Diprospan. Intermittent corticosteroids may also be prescribed if rheumatologic disease has worsened. Tablet forms of the drug are suitable, including Prednisolone, Dexamethasone.
- Muscle relaxants. These drugs relax muscles and relieve pain associated with excessive spasticity. In many diseases of the spine, muscle imbalance is observed, which consists in the fact that some muscles are in a reduced tone, while others are in increased tone.Muscle spasms need to be relieved for the pain to go away. Muscle relaxants are effective when taken as a course. The duration of therapy is selected individually. Examples of drugs are Baclofen, Sirdalud, Midocalm.
- Neurotropic vitamins of group B. If the patient has a pinched nerve roots against the background of the growth of osteophytes, then it is necessary to use vitamins of group B in large doses. Thiamine, pyridoxine and cyanocobalamin are able to eliminate pain when taken as a course, as part of a complex drug treatment.For several weeks, the patient is prescribed an injectable form of release, and then switched to tablets. The duration of therapy is selected individually. Examples of drugs are Neurorubin, Milgamma, Neuromax.
These medicines help with pain caused by sudden flare-ups. When the discomfort has subsided, supportive aids can be given to the patient:
- Chondroprotectors. With prolonged course use, these substances nourish the cartilage tissue and reduce the risks of accelerated destruction.Usually glucosamine and chondroitin are used as active agents. These components are not able to stop the degenerative processes occurring in the joints, but with the regular intake of chondroprotectors, prevention of deterioration occurs. Examples of medicines are Dona, Hondrogard, Mucosat.
- Calcium in combination with D3. Cartilage strength is correlated with bone strength. The main building material for bones is calcium. With a lack of calcium, bone resorption occurs, which leads to a tendency to fracture and the formation of kidney stones.For calcium to be absorbed, it is necessary to take additional vitamin D3. Without this component, taking calcium tablets is ineffective. With combined treatment, calcium is fixed in the bones, which significantly reduces the risk of fractures and degenerative processes in the spine.
Less commonly used homeopathy or folk recipes. This last point must be viewed with caution. Traditional medicine does not have a solid evidence base, therefore, in the absence of drug therapy, self-medication can be harmful.
Conservative methods of treatment for spondylosis of the spine
In the period after an exacerbation, most doctors prescribe supportive complex procedures aimed at restoring the patient’s well-being. These recommendations are relevant for people with an unsettled stage of the disease, which can last for many years if actively counteracting the progression of pathology with the help of auxiliary procedures.
What complexes of influences are more effective in the rehabilitation period:
- Physiotherapy exercises.Exercise helps maintain posture and strengthens the muscle core, which is an important step in improving your well-being. The work of the exercise therapy instructor is to show the correct technique for performing the exercises. Classes are aimed at developing flexibility, improving blood circulation and strengthening weak muscle groups. Over time, the patient will learn how to properly perform the complexes at home. For the first few months, it is advisable to train under the supervision of a specialist.
- Physiotherapy. With the help of apparatus action in combination with medications, painful sensations in any part of the spine are relieved. The recommended procedure is electrophoresis. With the help of a special hardware device of a certain frequency, they begin to direct radiation to the affected area of the spinal canal, after applying a drug to the skin. B vitamins, ascorbic acid, dimexide or heparin are usually used. As a result, heating occurs, an improvement in blood flow in the vessels, which leads to the complete elimination of chronic pain.
- Massage. This type of conservative treatment often helps with severe muscle pain associated with spasm. Since such deterioration occurs frequently in degenerative diseases of the spine, massages are an irreplaceable procedure. The action of the hands temporarily improves blood flow, which causes the tightened muscles to relax. You need to do the procedure for several days in a row to feel relief. It is recommended to carry out the procedure in a series of 10 sessions, several times a year.
Wearing a bandage for diseases of the spine
Special support corsets can improve the patient’s well-being if he has chronic back pain. The essence of the bandage is simple – the device partially relieves the load from the affected area of the spine, and if the pain is really associated with muscle weakness, an elastic corset can help for a while. You cannot wear a bandage for days, otherwise muscle atrophy will occur and subsequently the patient will harm himself even more.
Before going to bed, the elastic belt must be removed. It is recommended to wear a bandage for prolonged static loads, if you need to stand or sit for a long time. The duration of wearing should not exceed 2-3 hours without a break, after which you need to remove the belt. In the interval between wearing, it is useful to do restorative exercises.
It is not recommended to choose a bandage on your own. If the attending physician considers that such support is necessary, he will provide the name of the model and the manufacturer. Then the patient chooses the bandages according to the size in the salon of medical devices.Elastic corsets are measured in a horizontal position. It is necessary to ensure that the device does not press anywhere and sit comfortably on the buyer.
Operation to remove osteophytes
In advanced cases, when osteophytes have reached a large size, it is recommended to carry out surgical intervention. Removal of spinous growths will ease the patient’s condition, relieve pain. Such operations return patients to normal life, so they should not be postponed if doctors insist on a radical solution to the problem.
The essence of the surgical intervention is to remove the overgrown bone tissue. At the second stage of treatment, osteosynthesis is performed, which is necessary to connect the intervertebral discs. It is important to understand that surgical treatment does not protect against recurrence, so it is necessary to identify the cause of the disease. In the future, this will help to avoid re-illness.
Prevention of spondylosis of the spine
There are no special measures to prevent the onset of the disease.It is possible to apply in practice the general recommendations aimed at preventing the occurrence of complications from the ridge, which include:
- Maintaining correct posture. With improper sitting or standing, an uneven distribution of the load on the spine occurs, which negatively affects muscle tone. As a result, the spine is curved, which provokes scoliosis.
- Wearing orthopedic shoes. The absence of a high heel relieves stress on the legs and lower back.
- Refusal to lift weights.
- Maintaining a healthy lifestyle, quitting smoking and alcohol.
- Maintaining an active lifestyle. Recommended loads are swimming, moderate running, or brisk walking.
Lumbar spondylosis requires comprehensive, qualified medical assistance aimed at relieving pain and eliminating the cause of the disease. More detailed information about the pathologies of the spine can be found on our website from studying thematic articles.If you have any questions, you can leave comments.
90,000 Vertebral pain syndrome (back pain due to problems with the spine): why it occurs and how it manifests itself
As a rule, patients with complex dystrophic changes come to the doctor for pain in the spine. Simply put, they have already affected all the bones, joints and soft tissues of the spinal column. There are five types of such changes in total:
1. osteochondrosis (disorders in the articular cartilage),
2.deforming spondylosis (proliferation of vertebral tissue in the form of protrusions and spines),
3.intervertebral arthrosis (destruction of intervertebral joints),
4. ankylosing hyperostosis (ossification of the ligaments with limited mobility),
5. disc calcification (deposition of salts in spine).
A common cause of pain in any part of the spine – cervical, thoracic, lumbar or sacral – is compression (squeezing) of the spinal cord, its membranes and roots, nerves extending from it.Compression is caused by central or lateral stenosis (narrowing) of the spinal canal.
Poor muscular development of the neck and back leads to an overload of the spine. Add to it a variety of pathological processes and get degenerative-dystrophic, that is, destructive changes in the intervertebral discs and joints. In the joints, they begin with synovitis (inflammation with the release of excess fluid) and turn into subluxation. In the discs, changes are manifested in the flattening of the discs and disruption of their function, which is why they become unstable when moving.All this leads to dynamic stenosis (narrowing) of the spinal canal, which occurs during flexion, extension or rotation (rotation) of the vertebrae.
The further, the more the spinal canal narrows until it stabilizes in this compressed state. Sometimes this is due to bony growths or an increase in articular processes – they take up space. Another common cause is cartilage hernia. A hernia is a protrusion of a part of the disc backward, which entails a central stenosis of the spinal canal, or to the side, which leads to lateral stenosis and narrowing of the canal in which the nerve root is located.
Functional radiographs of the intervertebral disc can be seen. Usually they are done in a lateral projection, lying down, with maximum flexion and extension of the spine. It is much better if it is possible to get an X-ray while standing or sitting.
What does the radiograph of a “problem” spine look like? With flexion, extension, or rotational movements, either blockage or instability of the affected segment is noticeable. This means that in functional images either the relationship between two adjacent vertebrae does not change at all, or, on the contrary, their increased mobility arises until one of the vertebrae slides in relation to the other.
To successfully treat back pain (spine pain), it is extremely important to correctly identify the cause. Magnetic resonance imaging has become the main method for diagnosing vertebral pain syndrome. Measuring the spinal canal, determining the degree and type of its deformity, identifying calcifications (salt deposits), hypertrophy of the ligaments, cartilaginous hernias, arthrosis of the intervertebral joints, tumors in the spinal canal, assessing the state of the spinal cord – this is not a complete list of the possibilities of MRI of the spine.90,023 90,000 treatment of the disease in the clinic “Workshop Health” in St. Petersburg
Group of diseases:
Diseases of the spine
Cervical spondylosis is a disease of the spine. With spondylosis, bone growths are formed – osteophytes. They compress the nerve roots, blood vessels and the spinal cord. The disease most often develops after 50 years. Without proper treatment, the disease leads to complications.
How cervical spondylosis occurs
Spondylosis is the growth of bone tissue along the edges of the vertebrae at the attachment points of the longitudinal ligaments of the spine.These bone growths are also called osteophytes. The disease occurs when the head and neck are in the wrong position for a long time. The disease is common among office workers who spend all day at the computer.
In case of spondylosis, the vertebrae, which were previously connected by flexible and elastic tissue, begin to connect with bone, hard, not bending. As a result, the connection, which until recently was mobile, becomes rigid, fixed. A person can no longer move with the same freedom – and this can lead to negative and even dangerous consequences for health.
Spondylosis warns of itself with acute attacks of pain in the neck, back of the head or shoulders. If you experience this pain, try changing your position to a more comfortable one. Did not help? Perhaps attacks of such pain are the first signs of cervical spondylosis.
Symptoms of cervical spondylosis
Symptoms of cervical spondylosis are:
- persistent pain in the occiput and shoulder girdle;
- pain is given to the area of the ears, eyes, shoulder joints;
- restriction of neck mobility when turning the head to the side;
- neck crunch;
- Pain, numbness and tingling in the arm.
Why is cervical spondylosis dangerous
Spondylosis in the cervical spine can cause vascular disorders, headaches, dizziness, tinnitus and ringing in the ears, visual impairment, pressure surges. Due to the proliferation of osteophytes, the spinal canal narrows, arteries and nerves are pinched, and vertebral stenosis occurs. And stenosis is accompanied by a symptom of “false lameness”: a constant sensation of pain, stiffness or stiffness of one or both legs. The pain does not stop even during stops.
Often spondylosis becomes the cause of intervertebral hernia, which causes pain in various parts of the body, numbness of the extremities, and disturbances in the functioning of organs.
In December 2020, after a spinal injury, she could not move. On call from the clinic Baratov V.V. came to the house with a nurse. After examination, he was diagnosed with a compression fracture of certain vertebrae and found additional hernias of the spine.He ordered an examination and complex treatment, organized the delivery of a corset, the nurse made a blockade and an IV. In January 2021, she did an MRI of the spine and the diagnosis was fully confirmed. This is high professionalism, which is already an infrequent phenomenon. Other doctors have argued that a diagnosis cannot be made without an MRI. I am very grateful to Valery Vladimirovich for real help and I wish him HEALTH!
To avoid complications, consult a specialist at the first symptoms of the disease.The doctor of the “Workshop of Health” will ask you about the symptoms, conduct an examination and make an accurate diagnosis using a comprehensive examination. You can help the doctor if you remember when the pain started. The doctors of our clinic in St. Petersburg use the following diagnostic methods:
Treatment of cervical spondylosis
Doctors of the “Workshop of Health” treat cervical spondylosis without surgery. Non-surgical methods relieve the symptoms of the disease and heal the body.
Our doctor draws up a course of treatment individually for each patient. The course takes into account the diagnosis, age, gender and characteristics of the patient’s body. The patient needs to undergo procedures 2-3 times a week. Treatment for cervical spondylosis will take 3 to 6 weeks. The course of treatment consists of the following procedures:
Stages of the disease
The danger of cervical spondylosis directly depends on what stage it is at. Also, the approach to treatment and the complex of therapeutic procedures that will be prescribed by the attending physician depend on the neglect of the disease.The following stages of pathology development are distinguished:
- First stage. The cervical bend is already broken, the first signs of numbness and stiffness of the neck begin to appear, but so far the movements are not limited, osteophytes are still within the vertebrae. This is the stage at which therapy will be most effective and most likely to lead to a full recovery.
- Second stage. Osteophytes begin to gradually grow together with each other (although they still do not make it to the end). As a result, the intervertebral vertebrae begin to seriously squeeze.Mobility is limited, there is a possibility of getting a third degree of disability.
- Third degree. Osteophytes grow together almost entirely. A person loses mobility to such an extent that he can no longer fully engage in any serious activity. He is credited with the second, or, with a particularly serious development of the disease, even the first degree of disability.
Remember, the later you see a specialist, the greater the risk that the disease will move to a stage where its therapy will be problematic.With cervical spondylosis, treatment with is most effective only in the early stages.
Doctors of the “Workshop of Health” treat cervical spondylosis without surgery. Non-surgical methods relieve the symptoms of the disease and heal the body.
Our doctor draws up a course of treatment individually for each patient. The course takes into account the diagnosis, age, gender and characteristics of the patient’s body. The patient needs to undergo procedures 2-3 times a week. Treatment for cervical spondylosis will take 3 to 6 weeks.The course of treatment consists of the following procedures:
Treatment of cervical spondylosis in the “Workshop of Health” in St. Petersburg solves several problems:
- relieves back and chest pain;
- improves the condition of the cartilage of the intervertebral discs;
- strengthens muscles and improves posture;
- improves blood circulation in the spine and surrounding tissues;
- reduces the pressure of the bones against each other and strengthens the bone structures of the spine.
To improve the condition of the intervertebral discs, we prescribe chondroprotectors – drugs that nourish and restore disc cartilage. Massage of the collar zone of the back improves blood circulation in the spine, allows nutrients to better penetrate to the affected area. But hirudotherapy stimulates blood circulation best of all. To reduce pain, we use reflexology, massage, physiotherapy.
After completing the course, the doctor gives the patient a manual with exercises to strengthen the muscles of the back and neck.The patient can come to the doctor’s consultation free of charge within a year after the end of the course.
Causes of spondylosis
The disease manifests itself when a person’s so-called longitudinal ligament, which connects the anterior part of the cervical vertebrae, is torn. As soon as this happens, the growth of bone tissue described above begins. There are a number of factors contributing to damage or rupture of the longitudinal ligament and the subsequent formation of spondylosis. These include:
- Sports, domestic and professional injuries and overloads.
- Prolonged sitting.
- Posture disorders.
- Flat feet.
- Aging of the body.
- Inflammation of the intervertebral joints (arthritis).
- Flat feet.
- Aging of the body.
Prevention of spondylosis
Doctors of the “Health Workshop” advise to avoid neck problems:
- sleep on an orthopedic mattress;
- to do swimming, yoga;
- walk more;
- keep your back and head straight when walking and at the computer;
when working at a computer, take a break every 2 hours and perform exercises: circular movements with the shoulders, bends in different directions.
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90,000 reasons, symptoms, diagnosis and treatment in Chelyabinsk
What is spondylosis (spondyloarthrosis)
Spondylosis deformans (spondyloarthrosis) is a disease of the spine caused by degenerative changes in the bone tissue of the vertebrae. During the destructive process with spondylosis, growths are formed along the edges of the vertebrae – osteophytes, they pinch the nerve endings, causing acute pain.
With advanced forms of spondylosis, osteophytes completely fill the intervertebral space, and the spine in this segment completely loses its mobility.
It is believed that spondylosis is a disease of the elderly.
Clinical symptoms of spinal spondylosis appear after 40 years. However, at a younger age, spondylosis (spondyloarthrosis) may simply not be felt.
According to medical statistics, men are more likely to suffer from deforming spondylosis.
Another feature: spondylosis cannot be completely cured; you can only stop further destruction and relieve pain symptoms.
But in the absence of treatment for spondylosis, the pathological process will go further, and other vertebrae will be deformed.
There are three types of spondylosis (spondyloarthrosis): cervical, thoracic and lumbar. More often than others, there is cervical spondylosis, or cervical spondylosis in combination with lumbar spondylosis.
Causes of spondylosis of the spine
Age-related changes in the spine and metabolic disorders are the main causes of deforming spondylosis. In adulthood, blood supply and tissue nutrition deteriorates, this is the start for various pathological processes.
In young people, deforming spondylosis can cause: injuries, improper load distribution, curvature of the spine, excess weight.
Representatives of mental professions are at risk for spondylosis.They are for a long time in a forced static (not always correct) posture, bending over papers or at the computer.
Therefore, it is the cervical deforming spondylosis (spondyloarthrosis) that is most widespread.
The difference between spondylosis and osteochondrosis
Deforming spondylosis of the spine is not an independent disease, but rather the body’s response to other existing health abnormalities.
Osteophytes with spondylosis begin to grow when the intervertebral discs are destroyed and the shock-absorbing function of the spine is disturbed.
In other words, the inner part of the intervertebral disc suffers with osteochondrosis, and with spondylosis, the outer edge is damaged.
Therefore, during the treatment of spondylosis of the spine, it is important to eliminate the original cause of spondylosis – osteochondrosis, pathological displacement of the vertebrae and spasm of the surrounding muscles.
Degrees and symptoms of deforming spondylosis of the spine
There are three degrees of spondylosis. Symptoms of spondylosis may differ depending on the stage of development and the site of localization.
Spondylosis of the 1st degree – remains unnoticed for a long time. With deforming spondylosis of the 1st degree of the cervical spine, the blood supply to the brain may be disrupted (if the deformed vertebrae compress the vertebral artery).
In this case, the symptoms of grade 1 spondylosis will be: headache, pressure surges, dizziness, and general ill-health. And also deforming spondylosis of the 1st degree is manifested: muscle pain in the upper body, limited neck movement when turning and bending.
Spondylosis of the 1st degree of the thoracic spine – practically has no symptoms. This area of the spine is well supported by the muscle corset and ribs.
Symptoms are possible with spondylosis of the 1st degree on the part of the autonomic system: rapid pulse, pain in the chest, shortness of breath.
At the onset of the second stage of development of spondylosis of the spine, intercostal pain and pain in the region of the heart may occur.
Spondylosis of the 2nd degree of the lumbar spine – has the most pronounced symptoms of spondylosis (due to pinching of large nerve nodes): pain in the lower back, radiating to the pelvis and legs, numbness and twitching of the extremities (“cotton” or “wooden” legs), impaired coordination.
Vegetative syndromes with deforming spondylosis of 1 and 2 degrees of the lumbar spine: back pain, frequent urination, numbness of the skin on the legs.
The third degree of spinal spondylosis is the most dangerous.Regardless of the location of the spondylosis, at this stage, due to constant irritation of the nervous system, internal organs can be affected.
Serious damage to the spine with grade 3 spondylosis (spondyloarthrosis) can lead to complete immobility and disability.
Treatment of spondylosis deformans
Spondylosis of the spine is a chronic disease that can progress for many years. At the first symptoms of spondylosis or suspicion of it, you need to consult a doctor and begin treatment for spinal spondylosis as early as possible.
Eliminating the cause, relieving pain and inflammation are the priorities in the treatment of deforming spondylosis. Of the medicines for the treatment of spondylosis, anti-inflammatory, analgesic drugs are prescribed.
Important: local anesthetics do not help in the treatment of spondylosis, but only temporarily block the unpleasant symptom. Anti-inflammatory drugs (ointments, creams) are not able to deliver nutrients deep to the lesion. Effective treatment can only be under the supervision of a physician.
Physiotherapy is actively used in the treatment of spondylosis. It helps to reduce the drug load on the body and helps to deliver active substances deep to the focus of pathology, improve blood supply in tissues and relieve painful symptoms of spondylosis.
Physical factors (heat, laser, electrical impulses) improve blood flow and increase the body’s receptivity, which makes the treatment of spondylosis more effective.
Belozerova’s clinic for apparatus therapy has collected a rich arsenal of techniques for the treatment of spinal spondylosis: VTES, HIL therapy, ultrasound therapy, UHF, laser therapy and others.
90,000 Spondylosis Treatment | Clinic “Esculap”
Spondylosis treatment will help:
- Get rid of pain symptoms
- Improve sleep quality
- The gait is normalized (becomes more stable)
- Replenish the lack of physical activity
- Stimulate metabolic processes in the spine
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Spondylosis is a disease that occurs due to degenerative changes in the spinal column.Spondylosis is characterized by the appearance of spiny bone growths on the vertebrae, which are called spondylophytes (osteophytes). The disease is accompanied by painful sensations, due to which sleep disturbance occurs, weakness in the limbs appears, and gait is disturbed. Manual therapy is an effective method of treating spondylosis. Unlike medications, which only eliminate the symptoms of the disease, manual therapy promotes a person’s recovery. Thanks to the mild hand effect used in manual therapy, improvements come quickly enough.
Manual therapy in the treatment of spondylosis stimulates metabolic processes in the spine, slows down changes in the tissues of the intervertebral discs. Also, this method improves blood circulation and nutrition of the discs, eliminates muscle spasms and inflammation. The actions of the chiropractor are aimed at eliminating pain sensations that have arisen due to pinching of nerve endings. Applying a certain technique, the chiropractor will relieve an acute attack of pain, thanks to which the patient’s well-being and his quality of life will improve.