Back Pain: Spondylosis, Spondylolysis, and Spondylolisthesis

Have you read your MRI report recently and ended up more confused about your low back pain than before you began? If so, you are not alone.  The medical terms for low back problems confuse many medical professionals who don’t deal with these issues on a regular basis.  The purpose of this post is to help explain what is going on with your back, so that you can make a more informed decision on which treatments to choose.

The 3 main terms we are going to discuss are spondylosis, spondylolysis, and spondylolisthesis.  Each is defined below and a general discussion of treatment options follows.

Spondylosis refers to degenerative osteoarthritis of the spine – essentially the space between adjacent spinal vertebrae narrows. Because this condition commonly occurs in the zygapophysial (facet) joints or the intervertebral discs, it is often referred to as facet syndrome or degenerative disc disease.

Spondylolysis is a defect of a vertebra in the pars interarticularis – most typically a stress fracture that is caused by repetitive trauma done to the lumbar spine from strenuous sports such as football, weightlifting, cheerleading, or gymnastics.  Spondylolysis is also linked to certain inherited spinal anatomy (increased size and shape of the L4 superior articular process).

Spondylolisthesis is the displacement of a vertebra, most commonly occurring after a break or fracture.  There are 2 common forms of spondylolisthesis.

Isthmic (spondylolytic) spondylolisthesis is the most common form, with a reported prevalence of 5–7 percent in the US population. It usually progresses from spondylolysis over time.

Degenerative spondylolisthesis develops as a long-term result of progressive spondylosis. Facet arthritis and ligamentum flavum weakness may result in slippage of a vertebrae. Degenerative forms are more likely to occur in women, persons older than fifty, and African-Americans.

Symptoms:

Spondylosis, spondylolysis, or spondylolisthesis can cause stiffness and pain in the spine (lower back pain or neck pain), however, when severe, the narrowing may cause pressure or compression of the nerve roots.  Compression of a nerve root emerging from the spinal cord may result in radiculopathy (sensory disturbances, such as severe pain, weakness, or tingling in the neck, shoulder, arm, back, and/or leg, possibly accompanied by muscle weakness).

Treatments:

Treatment begins with conservative therapy including: physical therapy (including yoga and pilates), anti-inflammatory medications, epidural steroid injections, facet joint injections, radiofrequency ablation, massage therapy, acupuncture, and chiropractic care.  Often a back brace will help patients, especially those with spondylolisthesis to perform certain activities with less pain.

If there is nerve root irritation or nerve root compression causing radiculopathy that is not improved with conservative care, decompression surgery may be very effective in relieving the pain.   Fusion surgery is a poor option for the treatment of spondylosis, but may be considered for severe cases of spondylolisthesis.

Regenerative medicine has recently emerged for spondylosis and spondylolysis.  There are several reports of long-term successful treatment of low back pain with both PRP (platelet rich plasma) therapy or stem cell treatments.

For those interested, I have included a video with some excellent exercises for low back pain.

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Defining Spondylosis, Spondylitis, & Spondylolisthesis

When dealing with lower back spinal issues, the terminology can be confusing. While some think certain terms are interchangeable, they actually describe different types of conditions that need unique care. Do you want to learn more about a recent “spondy” diagnosis related to your lower back pain? This guide will help you understand the differences among these conditions.

So what do these words mean? Each starts with the prefix “spondy”. This refers to the vertebral or spinal column. If you were diagnosed with any of these conditions, something in your spine is abnormal. This may worry you. After all, the spine is a very important part of your body. Don’t fret, some of these conditions can be treated conservatively. Surgery may be an option for more advanced cases. While a little scary, it may be the answer to finally enjoy the life you want to live.

Let’s take a look at the 3 “Spondy” conditions.

Spondylosis

Spondylosis can affect any region of the spine. It is most common in the neck and lower back. It involves a defect in the pars interarticularis–a piece of bone attaching the facet joints at the back of the spine. This condition is a form of spinal degeneration occurring due to the natural effects of aging. As we grow older, normal wear and tear, as well as cellular changes, affect the structure of the spine. As a result, the soft tissues supporting the spine–discs, muscles, tendons, etc.–slowly begin to deteriorate.

For example, the discs protecting the spine tend to dry out and lose shape as we age. This condition, known as degenerative disc disease, puts pressure on the discs and may cause a bulging or herniated disc. When the soft gel-like layer of the inner disc breaks through the thick fibrous tissue of the outer disc, it often affects spinal joints and can compress nerves. In addition, cartilage can wear away from the joints leading to facet joint osteoarthritis.

Spondylosis, however, doesn’t only affect older people. In fact, adolescents may develop the condition. Those participating in sports requiring repeated hyperextension of the lower back are at risk. This includes gymnastics, rowing, wrestling, and track & field sports. Younger people may not have many symptoms, so the condition may not get diagnosed. It spondylosis isn’t identified and managed correctly, however, it can result in more serious problems.

Diagnosing and Treating Spondylolysis

Young athletes and older adults suffering from lower back pain may want to get checked for spondylosis. One effective diagnostic test is the one-legged hyperextension maneuver. While standing in a certain one-legged position, the lumbar spine gets stretched out. If this position causes pain it may indicate this condition. Also, X-rays, a bone scan, or MRI can help with diagnosis.

Treating spondylosis often involves conservative treatments like back braces, pain medications, and stretching exercises. If these treatments aren’t effective, surgery may be an option. Spinal decompression surgery or spinal fusion surgery can help relieve pressure on the affected area and provide much-needed stabilization.

Spondylolisthesis

When spondylosis is left untreated, it may lead to spondylolisthesis. Spondylosis involves the separation of the pars interarticularis. In contrast, spondylolisthesis is defined by a slipped vertebra. When one bone of the spine slips forward over another, it causes damage to the spinal structure. In some cases, a stress fracture may be to blame. Other times, damage to the intervertebral discs may cause this instability of the spine.

Family history and even congenital defects can contribute to this condition. It is often the result of certain sports and physical occupations. The lower back is responsible for carrying a lot of the body’s weight. Some activities make the spine more prone to developing spondylolisthesis. For example, gymnasts, football players, and weightlifters of all ages can develop this condition. Those that work in warehouses or delivering packages are also susceptible since they may bear a lot of weight on one side of the body and do a lot of bending. In addition, age-related degeneration of the spinal structures plays a role.

Some people don’t even know they have spondylolisthesis. They may discover it while getting an X-ray for an unrelated problem. Others experience low back pain, leg pain, swayback, or a protruding stomach.

Diagnosing and Treating Spondylolisthesis

If an X-ray suggests spondylolisthesis, your doctor may perform other tests or diagnostic imaging to get a better look at the problem. For example, your doctor may ask you to bend certain ways during an X-ray to see if your vertebrae are moving or unstable. A CT scan or myelogram can also determine if nerves are affected.

During a physical exam, your doctor views your posture, range of motion, and overall physical condition. In addition, the doctor will test your reflexes as well as feeling for muscle spasms and abnormal curves in your spine.

Treating this condition often starts with conservative measures. Pain and anti-inflammatory medications may prove helpful. In addition, consulting with a physical therapist or chiropractor can help reduce pain and increase mobility by using exercises or manual manipulation. A back brace may also be useful in stabilizing the area. Some people also find relief with epidural steroid injections. Your doctor injects this combination of steroids and pain medications into the affected area reducing inflammation and discomfort.

If you suffer from severe pain or haven’t responded to conservative treatments, surgery may be the next option. Spinal fusion surgery can be an effective treatment. Since it is a significant surgery, recovery times may be longer than other orthopedic procedures. By stabilizing the spine, however, it can prevent further structural damage and restore function and mobility. Depending on your condition and the surgeon’s preference, a lumbar interbody fusion can be done through the front of your body (ALIF), back (PLIF), or a combination (TLIF).

Spondylitis

Spinal conditions can also be due to arthritis. This condition, sometimes known as spondyloarthropathy, is a type of inflammatory rheumatic arthritis. Unlike other forms of arthritis, it affects areas where the ligaments and tendons attach to the bones. Though the exact cause is unknown, many people with the gene HLA B27 tend to develop the condition. In addition, some research suggests an infection can trigger this condition.  

Spondylitis usually occurs in young adults between 17 and 35 years old. Symptoms include chronic pain and lower back stiffness that gets worse after resting for a long time. Many feel stiffness after waking in the morning or late at night. Over time, symptoms may reach other parts of the body. Stiffness and pain can extend to the upper spine and even the rib cage. In addition, inflammation can occur in the skin, eyes, and gastrointestinal tract.

There are many different types of arthritis that can affect the spine. For example, psoriatic arthritis is common with those who suffer from skin psoriasis. Also, reactive arthritis, occurs as a reaction to certain bacteria like Chlamydia. Another inflammatory condition, ankylosing spondylitis, may cause the vertebrae to fuse together.

Diagnosing and Treating Spondylitis

Your doctor or a rheumatologist can diagnose this condition. It usually involves a thorough physical exam including reviewing medical and family history. In addition, diagnostic imaging and blood work–testing for the gene HLA-B27–help to pinpoint this condition.

While there is no known cure for spondylitis, there are some ways to manage symptoms. For example, medications can help with pain and stiffness. Exercise and physical therapy is a great way to improve posture, increase flexibility, and decrease pain. Those with more severe cases of spondyloarthritis may benefit from surgery. When spinal structures are affected, a laminectomy or osteotomy can be beneficial. Also, severe damage may require a spinal fusion surgery where vertebrae grow together using a bone graft and other instrumentation.

Getting Help for Your Spinal Conditions

If your lower back pain is caused by issues of the spinal column and related structures, you want the best care during every step of treatment. After all, spine and spinal cord health are crucial to your everyday functioning. It’s best to choose trusted doctors with years of experience in treating spinal disorders.

The Advanced Spine Center is ready to help. Our multidisciplinary team specializes in effective conservative treatments as well as the latest minimally invasive surgeries. Looking for award-winning, experienced doctors? We have you covered. With over six decades of combined experience as well as Top Doctor and Patient’s Choice awards, you have the comfort of knowing our team has successfully treated many spine conditions for years.

Don’t let lower back issues keep you from doing what you love. Call (973) 538-0900 to schedule a consultation and start your relationship with a caring team of professionals.

What is Deforming spondylosis? Spondylarthrosis? Spondylolisthesis?

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Methods of treatment

Methods of diagnosis

Diseases and symptoms

These questions may arise in a patient after performing magnetic resonance imaging (MRI) of the spine. In the conclusion of MRI, these terms are often heard. Are these conditions independent diseases and why are they dangerous?

Spondylosis deformans usually accompanies osteochondrosis of the spine and is manifested by calcification of the edges of the intervertebral discs and the formation of bone outgrowths (osteophytes) along the edges of the vertebral bodies. This is the age-related process of “aging” of the spinal column. For many years it proceeds without symptoms. Progression leads to limited mobility and intermittent pain in the neck, interscapular region and lower back. Large osteophytes put pressure on the nerve fibers and vessels of the spinal column, which is manifested by “lumbago” in the back, girdle pain in the chest, dizziness and headache.

Spondyloarthrosis is a chronic inflammation of the small “facet” joints of the spine. A characteristic manifestation is back pain during active physical activity: tilt, extension and rotation of the body. Often, spondyloarthrosis is accompanied by thickening (hypertrophy) of the yellow ligaments between the vertebrae. Hypertrophy of the yellow ligaments and arthrosis of the “facet” joint leads to narrowing of the spinal canal and intervertebral foramen. There are symptoms of compression of the spinal nerve root (as with a herniated disc): pain that radiates to the arm, leg, a feeling of “needles, goosebumps”, decreased sensitivity and strength of the fingers and toes.

Spondylolisthesis – displacement (slipping) of a vertebra relative to the underlying vertebra. The main reason: the inability of the ligaments of the spine to hold adjacent vertebrae on top of each other (instability of the spinal motion segment). Spondylolisthesis can be the result of trauma or damage to the spine during heavy physical or sports activities. Congenital listhesis is formed with dysplasia (impaired development of the vertebrae) in childhood; age-related, involutive against the background of the progression of osteoporosis, osteochondrosis and intervertebral hernias. There are anterior (antelisthesis), posterior (retrolisthesis) and lateral displacement. The patient is troubled by sharp pain in the back when bending slightly, for example, “wedging the back” when bending over the sink while washing. Other characteristic symptoms: a decrease in strength and sensitivity in the legs, are associated with compression of the roots and spinal cord in severe spondylolisthesis. When viewed at the place of displacement of the vertebra, there may be a “step”, a depression. Displacement of the vertebrae leads to deformation of the spinal column, narrowing of the spinal canal and requires mandatory consultation with a vertebrologist or orthopedist.

The main methods for diagnosing spondylosis and spondylolisthesis are spinal radiography, magnetic resonance imaging (MRI) and computed tomography (CT). Osteoporosis is diagnosed by ultrasonic and X-ray densitometry, determining the level of calcium and vitamin D3 in the blood. Electromyography (EMG) will allow you to assess the conduction and degree of compression of the roots and nerves of the extremities.

Treatment of Spondylosis and Spondylarthrosis in Samara

The treatment is aimed at reducing pain in the spine, relaxing the back muscles, and as a result, increasing the range of active movements. Complex therapy includes non-steroidal anti-inflammatory drugs, muscle relaxants, chondroprotectors. In order to improve blood flow in the basin of the vertebral arteries and facilitate venous outflow from the spine, mesoinjection therapy is used. If osteoporosis is detected, the doctor will prescribe vitamin D3 and calcium preparations, as well as stimulants for the formation of bone tissue.

For quick relief of pain, it is important to prescribe hardware high-tech techniques. The use of shock wave therapy is aimed at reducing muscle spasm and inflammation of the “facet” joints, improving the blood supply to the spine and restoring the bone structure of damaged vertebrae. Peripheral magnetic stimulation “evens out” muscle tone in the epicenter of pain, stimulates blood circulation and conduction through the peripheral nerves of the back and limbs. Another method of magnetic stimulation is also actively used on the magnetotherapeutic complex “Multimag”. Its action helps to restore damaged joints of the spine and reduce inflammation in them, soothes and relaxes the muscles of the back, stimulates the functions of the brain and spinal cord. To improve the trophism of the nerves and the musculoskeletal system of the spinal column, Khivamat therapy is prescribed. Electrostatic pulses create deeply penetrating vibrations in the tissues, which leads to effective pain relief and a decrease in inflammation in the joints of the spine, improving lymphatic and venous drainage of the tissues of the back.

In the treatment of spondylolisthesis, in addition to medical and physiotherapeutic methods, orthopedic corsets are used that fix the spine and limit instability between the vertebrae. With increased displacement of the vertebrae and the appearance of neurological symptoms (decreased strength and sensitivity in the legs, urinary incontinence, change in gait), surgical treatment is indicated: immobilization of 2-3 adjacent vertebrae (spondylodesis).

It is important to note that all 3 pathological processes (spondylosis, spondyloarthrosis, spondylolisthesis) develop very slowly. Initially, they do not have characteristic symptoms, manifesting themselves only as periodic pain in the back and neck during physical exertion. Often, diagnosis is carried out after the onset of symptoms from the spinal cord and a violation of the musculoskeletal function of the spine. It is necessary not to miss the first “calls” of the disease, to consult a neurologist-vertebrologist and an orthopedist in a timely manner and to conduct an examination of the spine. At the initial stages, these pathologies are amenable to effective treatment using physiotherapy techniques, physiotherapy exercises and posture correction.

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What is the danger of spondylosis of the lumbosacral region?

Home / Blog / Why is spondylosis of the lumbosacral spine dangerous?

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Spondylosis in the lumbosacral spine is a disease of degenerative-dystrophic origin, which causes destruction of bone and ligamentous structures.

Quite often the term spondylosis is confused with other diseases:

Causes of lumbar spondylosis

Spasmodic shortened muscles are the main cause of this disease. In particular, the paravertebral muscles, which are woven into the spinal column, both from the back and from the abdomen. With round-the-clock muscle tension, the spinal column falls into the muscle “vice”. As a result, the development of degenerative destruction occurs mechanically. In addition to this process, not only the vertebrae themselves are destroyed, but also the intervertebral discs, resulting in protrusions and hernias.

Initial signs of spondylosis of the lumbosacral spine

Statistics say that only 30% of patients with spondylosis in the lower back, the disease occurs without symptoms. But in most people, disorders in the spine are manifested by sharp pain due to compression of the nerve roots. This compression of the nerve structures occurs due to the presence of osteophytes, protrusions, herniated discs. Such pathological development leads to a deterioration in the quality of life.

Let us repeat, the disease occurs as a result of muscle spasm around the clock. When spondylosis has already arisen, then pain symptoms can be not only due to compression of the nerve structures. But also due to the presence of trigger points in the thickness of spasmodic shortened muscles.

Preferred myofascial massage – with the study of trigger points. It allows, firstly, to eliminate the trigger-source of pain, and secondly, it makes the muscle homogeneous in structure. True, this is not enough for success. Since the muscle remains functionally shortened, the presence of a trigger point obliges the muscle to a constant spasm, and it ceases to stretch to its normal length. Therefore, in parallel with the targeted study of the trigger, it is necessary to stretch the muscle to its physiologically normal length. Preference should be given to passive stretching: when the patient himself relaxes, and the specialist separates the muscle attachment points from each other with his own hands, using post-isometric relaxation techniques. Even if spondylosis of the spine is diagnosed, the whole body must be worked out: from the base of the skull to the heels. The course of treatment is prescribed by the doctor, only after a thorough examination and study of the images.

Also, in addition to pain, the patient may experience tingling, goosebumps, numbness of the limb/toes. Such sensations also arise due to compression of the nerve structures in the lumbosacral spine. If the compression of the nerve structures is very strong, then the patient can also observe muscle weakness in the lower limb.

If these symptoms occur, you should immediately go to the doctor.

Diagnosis of spondylosis of the lumbar spine

First of all, the diagnostic measure of the disease is to examine the patient, find out complaints, the doctor palpates the body. Next, an X-ray examination of the spinal column is prescribed. These methods include computed tomography, magnetic resonance imaging or radiography.

Magnetic resonance imaging makes it possible to study in detail the soft structures of the body – the spinal cord, roots, ligaments, intervertebral discs. X-ray shows us directly osteophytes, the position of the vertebrae among themselves. Computed tomography shows us the spinal column to the smallest detail, and can provide information about small narrowing of the spinal canal – stenosis.

In order to check the exclusively nervous structures of the patient in more detail, the doctor prescribes electroneuromyography. This method makes it possible to open any damage to the nervous structures that cannot fully perform their main function.

Organic changes that are already visible on the pictures: protrusions, hernias, osteophytes – this is a consequence of a long-established pathology. The cause of compression of intervertebral discs and joints, nerve trunks and blood vessels is pathological tension and functional shortening of skeletal muscles affected by trigger points.

The mechanism is called auto-compression, or self-tissue clamping. “Osteochondrosis” will progress in stages in the case of traditional treatment: NSAIDs, muscle relaxants, hormonal blockades, apparatus physiotherapy. It is USELESS to anesthetize the clamped spine, to drip vascular preparations through the clamped vessels. It is necessary to eliminate the cause, and not fight the effect.

After the patient has been diagnosed, treatment is prescribed, which is aimed at treating the CAUSE of the disease.

Treatment of lumbosacral spondylosis

It must be admitted that there is no such method that will give us the opportunity to return to us a healthy spinal column. After all, the disease is a degenerative-dystrophic process. It is very important to choose a treatment that will be aimed at preventing subsequent “breakdowns” in the spinal column. Once again, the cause of spondylosis is spasmodic shortened muscles that are burdened with trigger points. Therefore, it is necessary to do everything possible to remove the muscle vice from the spinal column, eliminate trigger points, and bring the muscles of the whole body to normal anatomical physiological length.

This requires an examination of the patient, it is necessary to undress the patient to his underwear, make a visual assessment of the body, identify the presence of asymmetries, curvature, shortening, restriction of movement. Then the presence of spasmodic muscles, trigger points is determined by palpation. For the patient, these places are painful. Various neurological and orthopedic tests may be performed. A diagnosis is made. If necessary, an additional examination is prescribed to clarify the diagnosis. Procedure sheets are filled out for specialists who will work with the patient.

The first procedure: myofascial massage – the task is to relax the muscle by pressing on the spasmodic muscle (ischemic compression).

The second procedure: kinesiotherapy with elements of post-isometric relaxation – a do-it-yourself specialist restores the length of shortened muscles by giving your arms, legs, torso certain postures.