Radiculopathy | Johns Hopkins Medicine

What You Need to Know

• Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column.
• The pinched nerve can occur at different areas along the spine (cervical, thoracic or lumbar).
• Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.
• A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.
• Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

What is radiculopathy?

Your spine is made of many bones called vertebrae, and your spinal cord runs through a canal in the center of these bones. Nerve roots split from the cord and travel between the vertebrae into various areas of your body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy.

Types of Radiculopathy

Radiculopathy can have different symptoms and different names depending on where in the spine it occurs.

Lumbar Radiculopathy

When radiculopathy occurs in the lower back, it is known as lumbar radiculopathy, also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. The lower back is the area most frequently affected by radiculopathy.

Radiculopathy Prevention

While radiculopathy can’t always be prevented, staying physically fit and maintaining a healthy weight may reduce your risk of radiculopathy. Using best practices for good posture while sitting, playing sports, exercising or lifting heavy objects is also important for preventing injuries.

Cervical Radiculopathy

Cervical radiculopathy describes a compressed nerve root in the neck (cervical spine). Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur.

Thoracic Radiculopathy

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body.

Symptoms of Radiculopathy

When a nerve root is compressed, it becomes inflamed. This results in several unpleasant symptoms that may include:

• Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing

• Weakness or loss of reflexes in the arms or legs

• Numbness of the skin, “pins and needles,” or other abnormal sensations (paresthesia) in the arms or legs

Your specific symptoms will depend on where in the spine the nerve root is pinched. However, it’s also possible that you don’t experience any symptoms or you go through periodic flare-ups of symptoms.

Causes of Radiculopathy

Radiculopathy is typically caused by changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord.

In most cases, foraminal stenosis is caused by gradual degeneration of the spine that happens as you age. But it can also be a result of a spinal injury.

Herniated Discs

One common cause of foraminal stenosis and radiculopathy is a bulging or herniated disc. Spinal discs act as cushions between your vertebrae. On occasion, these discs slip out of place or become damaged and press on nerves. This problem is most likely to occur in your lower back, but it can also affect your neck.

Bone Spurs

Another possible cause of radiculopathy that may lead to narrowing of foramina is bone spurs — areas of extra bone growth. Bone spurs can form in the spine due to inflammation from osteoarthritis, trauma or other degenerative conditions.

Other Causes

Thickening (ossification) of the spinal ligaments may also lead to narrowing of the space around the nerve roots and subsequent nerve compression. Less common causes of radiculopathy include spinal infections and various cancerous and noncancerous growths in the spine that may press against the nerve roots.

Radiculopathy and Myelopathy

Sometimes, radiculopathy can be accompanied by myelopathy — compression of the spinal cord itself. Herniated or bulging discs can sometimes press on the spinal cord and on the nerve roots. When the spinal cord is involved, the symptoms can be more severe, including poor coordination, trouble walking and paralysis.

Radiculopathy Versus Neuropathy

Radiculopathy symptoms may overlap with those of peripheral neuropathy, making it difficult to pinpoint the source of the problem. Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand. Consult a spine specialist for an accurate diagnosis.

Radiculopathy Diagnosis

Your doctor may take several steps to diagnose radiculopathy:

• A physical exam and physical tests may be used to check your muscle strength and reflexes. If you have pain with certain movements, this may help your doctor identify the affected nerve root.

• Imaging tests, such as an X-ray, CT scan or MRI scan, are used to better see the structures in the problem area.

• Nerve conduction studies, along with electromyography, can also be used to help pinpoint whether the problem is neurological or muscular.

Radiculopathy Treatment

Radiculopathy treatment will depend on the location and the cause of the condition as well as many other factors. Nonsurgical treatment is typically recommended first and may include:

• Medications, like nonsteroidal anti-inflammatory drugs, opioid medicines or muscle relaxants, to manage the symptoms

• Weight loss strategies to reduce pressure on the problem area

• Physical therapy to strengthen the muscles and prevent further damage

• Steroid injections to reduce inflammation and relieve pain

Some people may need more advanced treatments, such as surgery. Surgery is typically used to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine. This may involve removing all or parts of a disc and/or vertebrae. Cervical posterior foraminotomy is one of the minimally invasive spine surgery options available.

Cervical Spondylosis | Neck Pain | Symptoms & Treatment

In this series Neck Pain Whiplash Neck Sprain Torticollis (Twisted Neck)

This leaflet is aimed at people who have been told they have cervical spondylosis as a cause of their neck symptoms. Cervical spondylosis is a ‘wear and tear’ of the vertebrae and discs in the neck. It is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. Treatments include keeping the neck moving, neck exercises and painkillers. In severe cases, the degeneration may cause irritation or pressure on the spinal nerve roots or spinal cord. This can cause arm or leg symptoms (detailed below). In these severe cases, surgery may be an option.

Understanding the neck

The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae. The first two are slightly different to the rest, as they attach the spine to the skull and allow the head to turn from side to side. The lower five cervical vertebrae are roughly cylindrical in shape – a bit like small tin cans – with bony projections.

The sides of the vertebrae are linked by small facet joints. Between each of the vertebrae is a ‘disc’. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act like shock absorbers and allow the spine to be flexible.

Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways. (The muscles and most ligaments are not shown in the diagram, for clarity.)

The spinal cord, which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear (posterior) part of the brain.

Cervical spine

Side view of part of the spine

What is cervical spondylosis?

Cervical spondylosis is an age-related degeneration (‘wear and tear’) of the bones (vertebrae) and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30.

One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having ‘wrinkles in the spine’. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.

However, in some people, the nearby muscles, ligaments, or nerves may become irritated or pressed on by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people.

What are the symptoms of cervical spondylosis?

If symptoms develop, they can range from mild to severe. Symptoms may include:

• Pain in the neck:
  • This may spread to the shoulders and base of the skull. Movement of the neck may make the pain worse.
  • The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck.
  • The pain tends to come and go with flare-ups from time to time. You may have a flare-up of pain after unaccustomed use of your neck, or if you sprain a neck muscle or ligament.
  • However, a flare-up often develops for no apparent reason. Some people develop chronic (persistent) pain.
• Some neck stiffness, particularly after a night’s rest.
• Headaches may occur. The headaches often start at the back of the head just above the neck and travel over the top to the forehead.
• You may develop ‘pins and needles’ in part of an arm or hand. This symptom is caused by irritation of a spinal nerve as it leaves the bony (vertebral) area. However, do tell a doctor if loss of feeling (numbness) or weakness develops in a part of a hand or arm. These symptoms suggest more pressure on a nerve. This is called a ‘cervical radiculopathy’.
• More rarely, clumsiness of a hand, problems with walking, or problems with bladder function occur when pressure from a worn bone (vertebra) or disc damages the spinal cord. This is called ‘cervical myelopathy’. Again, it is important to report these symptoms to a doctor.

Note: cervical radiculopathy and cervical myelopathy are discussed further later in the leaflet. The following section concerns cervical spondylosis without radiculopathy or myelopathy.

What are the treatments for cervical spondylosis without radiculopathy or myelopathy?

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able to do so. You should not let it stiffen up. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day.

As far as possible, continue with normal activities. You will not cause damage to your neck by moving it. 

Medicines

Painkillers are often helpful.

• Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or in combination with paracetamol. They include ibuprofen which you can buy at pharmacies or obtain on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
• A low-dose tricyclic antidepressant, such as amitriptyline, is sometimes used for persistent (chronic) neck pain. The dose of amitriptyline used for pain is 10-30 mg at night. At higher doses, tricyclic antidepressants are used to treat depression. However, at lower doses they have been found to help relieve certain types of pain, including neck pain.

Physiotherapy

If symptoms do not improve over a week or so, you may then be referred to a physiotherapist to help with pain relief and for advice on specific neck exercises.

Various treatments may be advised by a physiotherapist. These include traction, heat, cold, manipulation, etc. The value of each of these treatments is uncertain, as the results of research studies looking at which treatments work best can be conflicting.

However, what is often most helpful is the advice a physiotherapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises.

Other treatments

Some other treatments which may be advised include:

• A good posture may help. Check that your sitting position at work or at the computer is not poor (that is, not with your head flexed forward with a stooped back). Sit upright. Yoga, Pilates and the Alexander Technique all improve neck posture; however, their value in treating neck pain is uncertain.
• A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.

Treatment may vary and you should go back to see a doctor:

• If the pain becomes worse or severe.
• If other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in a part of an arm or hand, as described previously.
• If you develop any problems with walking or with passing urine. Again these symptoms suggest that cervical myelopathy may be developing as a complication of the cervical spondylosis.
• If you develop dizziness or blackouts when turning the head or bending the neck. This can suggest that the vertebral artery which supplies the brain is being nipped by the degenerative changes in the spine.

Other pain-relieving techniques may be tried if the pain becomes chronic. For example, you may be referred to a pain clinic and a pain management programme may be offered to help you control and live with your pain.

Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated.

Cervical radiculopathy and cervical myelopathy

Cervical spondylosis is an age-related degeneration (‘wear and tear’) of the bones (vertebrae) and discs in the neck. It can progress to cause cervical radiculopathy or cervical myelopathy (described below). Most cases do not. However, it may be useful to be aware of the symptoms that suggest they may be happening, particularly as some of them may develop slowly. See a doctor if you suspect that you are developing cervical radiculopathy or cervical myelopathy.

Cervical radiculopathy

This occurs when the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region. Although there are other causes of radiculopathy, cervical spondylosis is a common cause.

Degenerative changes to the joints around the vertebrae and osteophyte formation produce areas of narrowing which may nip the nerve. Another cause is a prolapsed disc. This is sometimes called a ‘slipped disc’ although the disc does not actually slip. What happens is that part of the inner softer area of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. This presses on the nerve as it passes out between the vertebra (see diagram).

Cervical vertebra

As well as neck pain, symptoms of radiculopathy include loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm or hand supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain. There may be shooting pains down into the arm. The symptoms are usually worse in one arm but may affect both. The pain may be severe enough to interfere with sleep. The lower cervical vertebrae are the usual ones affected, causing these symptoms in the arms. However, if the upper vertebrae are involved, the pain and numbness occur at the back and the side of the head.

Your doctor may suspect a radiculopathy if you have the typical symptoms. A doctor’s examination may show changes to the sensation, power and tendon reflexes to areas of the arm supplied by the affected nerve. You may then be referred to a specialist for further tests. These may include an MRI scan which will show whether the nerve roots are being pressed on.

Treatment will depend on how severe the pressure and damage are. In many cases the symptoms settle over time. A course of physiotherapy or a neck collar used for a prescribed period may help. However, in some situations, surgery may be recommended which aims to relieve the pressure on the nerve. Depending on the cause, this may involve surgery to the disc or to the vertebra itself.

Cervical myelopathy

This occurs when there is pressure on or damage to the spinal cord itself. Again, cervical spondylosis is a common cause of this condition, as the degenerative changes to the vertebra can narrow the canal through which the spinal cord passes. A prolapse of a cervical disc can also cause myelopathy if the prolapse is into the central canal of the vertebra. This may happen suddenly or develop over a period of time. There are various other rare causes of cervical myelopathy. For example, a tumour or infection that affects this part of the spinal cord.

As the spinal cord is made up of groups of nerve fibres carrying messages to the brain from the rest of the body, pressure on these nerves in the neck region can produce symptoms from several parts of the body.

The symptoms of a cervical myelopathy may include:

• Difficulties with walking. For example, the legs may feel stiff and clumsy.
• Changes to the sensation of the hands. For example, it may be difficult to feel and recognise objects in the usual way and you may have a tendency to drop things.
• Problems with your bladder. For example, you may experience problems with emptying your bladder, or incontinence.

A doctor’s examination may show changes to the sensation, power and tendon reflexes to the legs and arms. You are likely to be referred to a specialist for further tests, usually an MRI scan. This will show how the spinal cord is affected and whether any surgical treatment to relieve the pressure is likely to help.  

causes, symptoms, diagnosis and treatment by a rheumatologist at the MCC “Proxima” (Sochi)

Spondylosis is a chronic degenerative process that occurs in the spine and is characterized by deformation of the anterior sections of the intervertebral discs, the appearance of osteophytes on their surface (bone growths) and narrowing of the spinal canal.

Causes of spondylosis

Spondylosis is a pathological disorder that affects the cervical part of the spinal column, vertebrae and adjacent discs between them. The disease is a gradual active degeneration affecting all bone and ligamentous structures of the spine. Spondylosis should not be confused with spondylitis, despite the fact that these two concepts are mistakenly considered synonymous.

Pathologies are characterized by slow destruction of intervertebral discs, vertebral bases, adjacent paravertebral tissues. In most cases, this degeneration of the spine is associated with dehydration of the intervertebral discs and causes wear of the posterior articular processes.

Practitioners believe that the occurrence of this pathology may be due to:

1. Injury to the spinal column.
2. Violation of metabolic processes.
3. Natural aging of the body.
4. Irrational distribution of the load on the spine.
5. Constitutional features.
6. Past infectious diseases.
7. Excessive physical exertion.

Specificity of the disease

Spondylosis is a widespread pathology among elderly and adult patients, as well as persons engaged in heavy physical labor. It has been scientifically proven that the disease is diagnosed in about half of male patients over 50 years of age and in 90% of female patients over 60 years of age. The disease has several varieties, as a result of which its resulting clinical manifestations are very heterogeneous.

Constant stress on the back or neck in daily life aggravates the disease. Due to additional bone growth, the human body tries to counteract the instability of the spine and thus strengthen it. Against this background, bone spurs or spondylophytes develop. They are diagnosed during a lifetime in most people. It is only when they compress blood vessels, nerves, or spinal canal that neurological disorders and neck/back pain occur.

Symptoms

The initial stages of spondylosis proceed without pronounced clinical signs – most patients note the appearance of aching pain and heaviness in the spinal column, stiffness of movements in the area of ​​the affected segment.

Progression of the pathological process accompanied by:

• increased pain;
• tension of the dorsal muscles;
• constant weakness;
• dizziness;
• tinnitus;
• sleep disorder;
• decreased visual acuity;
• difficulty with focus;
• changes in blood pressure;
• restriction of movement;
• false intermittent claudication;
• numbness of the extremities.

How do you know if you have spondylosis?

Spinal changes can be detected by taking a plain X-ray. In the future, in order to see possible compression of the nerve, it is necessary to undergo MRI diagnostics. With a referral from a family doctor / therapist and recent MRI results, you can safely turn to a surgeon for the diagnosis and treatment of spondylosis.

The course of the disease

The onset of spondylosis begins with a degenerative process of the intervertebral disc, which becomes thinner and more fragile, which causes a change in its “shock-absorbing” function.

Injuries of the spine are more or less serious and depend primarily on the work that the patient has done in the past (for example, masons, porters and builders subject their spine to a greater or lesser degree of constant stress), and the intensity that can ” felt” in old age, provoking sclerosis, bone irregularities, compaction of intervertebral discs, their wear at the level of cartilage between the joints, osteophytes.

With the development of spondylosis, the formation of a hard disc herniation, also called a disc-osteophyte beam, is possible, which is responsible for the progressive narrowing of the spinal canal.

Forms of spondylosis

According to the criterion of damage, the following types of spondylosis are distinguished:

1. Compression syndrome of the vertebral artery essential nutrients and oxygen and they die; scientists call this type of spinal cord injury myelopathy).
2. Spondylogenic compression (medical doctors understand this type of pathology as a narrowing of the spinal canal due to bone deformation; this so-called spinal canal stenosis presses directly on the spinal cord and regularly causes neurological complaints and constant severe back pain).
3. Spondylosis with radiculopathy (this form, known as radicular syndrome, refers to direct injury to the nerve root).
4. Spondylosis deformans (the process of forming a single structure as a result of connecting the bone processes of different vertebrae to each other, which limits the mobility of the spine).
5. Hyperostotic spondylosis (the form caused by the metabolic disease diabetes).

If neither myelopathy nor radiculopathy nor neurological disorders occur, the disease is classified as one of the other types of spondylosis.

Increased load or external impact on the spine in the form of violence or falls are other causes of spondylosis. In some cases, a genetic (hereditary) predisposition plays a certain role.

Diagnosis of spondylosis

The main method of differential diagnosis of spondylosis is x-ray examination , which allows to detect the presence of:

• osteophytes, having the appearance of a sharp point resembling a bird’s beak;
• neo-arthrosis – counter growths on the vertebral bodies;
• bone staples connecting the vertebrae and blocking movement in the affected area.

In contrast to osteochondrosis, there is no fusion of the spinous processes and their pain on palpation, the height of the intervertebral discs is preserved, no more than 2-3 motor segments are affected.

The results of electroneuromyography and dopplerography of cerebral vessels are used to detect neurological disorders.

Treatment of spondylosis

In spondylosis, therapeutic measures are aimed at preventing the progression of the degenerative process, the relief of the pain syndrome and strengthening the back muscles – the patient is recommended:

1. Correlation of lifestyle .
2. Physical activity restriction .
3. Elimination of permanent static loads .
4. Regular change of posture during sedentary work.
5. The use of vitamin-mineral complexes , chondroprotectors and non-steroidal anti-inflammatory drugs.
6. Physiotherapeutic procedures – electrophoresis, diadynamic therapy, ultrasound.
7. Therapeutic exercise , regular exercise of which improves the blood supply to the muscles and intervertebral discs.
8. Acupuncture .
9. Therapeutic massage with gentle osteopathic techniques.
10. Hirudotherapy .

Manual therapy, spinal traction and intensive massage are contraindicated for spondylosis!

Spondylosis Rehabilitation

Physiotherapy is almost always the best option for increasing spinal mobility. An individually designed training plan aims to stabilize the weakened intervertebral disc and stop or at least delay its further wear.

Where none of the therapeutic approaches work, sometimes only surgery remains. In order to relieve symptoms, the surgeon creates enough space for the affected intervertebral discs and nerves. Sometimes this requires strengthening individual vertebrae. Due to the risks (for example, in patients with osteoporosis) and possible side effects, such an operation is considered the last option of the decision made by the most reputable doctors.

Where outpatient treatment is insufficient or surgery is required, inpatient rehabilitation is recommended. Specialist clinics or rehabilitation centers with respective orthopedic specialists offer a wide range of therapy concepts.

In the case of conservative treatment methods (without surgery), the family doctor initiates orthopedic rehabilitation through authorized institutions or health insurance companies. In the rehabilitation center, as part of the treatment, an individual and intensive program is developed, designed for several weeks.

The chances of rehabilitation increase with the patient’s personal willingness to participate in it (for example, with the normalization of body weight). In most cases, conservative methods can achieve good results in terms of long-term improvement in the course of spondylosis.

Spondylosis – treatment, symptoms, causes, diagnosis

Spondylosis literally means hardening or fixation of the vertebrae as a result of pathological changes in the spine. Spondylosis is caused by degenerative changes in the spine, such as the formation of osteophytes (bone spikes) and degenerative-dystrophic changes in the intervertebral discs. Changes in the spine with spondylosis are referred to as osteoarthritis. For example, the phrase “spondylosis of the lumbar spine” means the presence of degenerative changes such as osteoarthritis in the intervertebral joints and the presence of degenerative changes in the intervertebral discs in the lumbar spine.

Spondylosis can affect all parts of the spine (cervical thoracic lumbar), but the most common is cervical and lumbar spondylosis. Thoracic spondylosis often causes no symptoms. With lumbosacral spondylosis, changes occur not only in the lumbar spine, but also in the sacral region. There are several medical terms that are similar in name to spondylosis and are therefore often confused. These are terms such as:

• spondylitis: inflammation of one or more vertebrae of infectious (including specific genesis) or non-infectious genesis (in inflammatory diseases such as ankylosing spondylitis). Spondylitis is a completely different disease, because in spondylosis degenerative processes take place, while spondylitis is an inflammatory disease
• spondylolysis: incomplete development and formation of the articular part of the vertebra (pars interarticularis). This defect predisposes to spondylolisthesis due to the development of motor segment instability
• spondylolisthesis: displacement forward or backward of the vertebral body in relation to the underlying vertebra. For example, L4 to L5 anterior spondylolisthesis means that the fourth lumbar vertebrae has moved forward relative to the fifth vertebra. As a result, the geometry of the spine changes.
• spondylosis deformans : occurs due to the growth of osteophytes or bony bridges around a degrading intervertebral disc (this term is almost synonymous with spondylosis).
• stenosis: narrowing of the spinal canal. This is a narrowing of the spinal canal that limits the space needed for the spinal cord and nerves. Pressure on the spinal cord and nerves due to the narrowing of the spinal canal can cause symptoms such as pain, numbness, and tingling.

Causes and risk factors

Spondylosis is an age-related change in the spine. As we age, the bones and ligaments in the spine wear down, resulting in bony growths. In addition, intervertebral discs degenerate, weaken, which can lead to the formation of protrusions or herniated discs. The cause of early spondylosis may be heavy physical exertion of a professional nature. Spondylosis is quite common. The first symptoms may appear between the ages of 20 and 50. More than 80% of people over the age of 40 have radiographic evidence of spondylosis. The rate of development of spondylosis depends on both genetic factors and the presence of injuries or excessive loads on the spine.

Symptoms

Many people who have spondylosis on x-ray have no symptoms. Statistically, lumbar spondylosis , present in 27%-37% of people without any symptoms.

In some people, spondylosis causes back and neck pain due to nerve compression. Nerve compression is caused by herniated discs or osteophytes in the facet joints, which narrow the space where the nerves pass and cause spinal or foraminal stenosis. Even with small disc herniations, when they do not cause root compression, local inflammation and irritation of nerve fibers are possible. In addition, herniated discs can put pressure on the ligaments of the spine and cause pain. With compression, conditions arise for stimulating the growth of blood vessels and nerves, and this leads to a chronic pain syndrome. With pain syndrome, individual parts of the spine try to compensate for pain, and as a result, areas of soreness, muscle spasm, and trigger points appear.

Symptoms of spondylosis include localized pain in the area of ​​the spondylosis, usually in the lower back or neck. If a herniated disc causes nerve compression, the pain may radiate to the limb. For example, large disc herniations in the lumbar spine can compress a nerve and cause pain that starts in the lower back and then travels down one leg and foot. This condition is commonly referred to as sciatica. Back pain due to a herniated disc typically worsens with prolonged standing, sitting, and leaning forward, and often improves with changes in position and walking. Back pain due to arthrosis of the facet joints is usually worsened by walking and standing, and relieved by straightening the torso. Nerve compression can cause numbness and tingling. With severe compression of the nerves, muscle weakness in the limb may appear. If a herniated disc puts pressure on the spinal cord, it can cause damage to the spinal cord (myelopathy). Myelopathy symptoms include numbness, tingling, and muscle weakness. For example, a large herniated disc in the cervical spine can lead to cervical myelopathy, resulting in symptoms such as numbness, tingling, and weakness in the arms and possibly legs. As a rule, patients with spondylosis have already been in contact with doctors, since CT or MRI radiography well visualize changes in the spine characteristic of this disease. The reason for the obligatory visit to the doctor are the following reasons:

• No effect of prescribed treatment
• Presence of evidence of acute nerve dysfunction (eg, weakness in one or more limbs)
• Bladder or bowel dysfunction, accompanied by acute back or neck pain, indicates severe nerve dysfunction and requires hospitalization
• Numbness in the groin or ischial area may indicate serious dysfunction of the nerve structures and also requires immediate hospitalization.

Diagnosis

Spondylosis is diagnosed using radiological methods such as plain radiography, MRI or CT. Radiography allows visualization of osteophytes, thickening of the joints and a decrease in the distance between the vertebrae. A CT scan of the spine is able to visualize the spine in more detail and can diagnose narrowing of the spinal canal (stenosis) if present. An MRI study is the most informative and allows you to visualize soft tissues (disks, ligaments, nerves) and diagnose the presence of compression of nerve structures, which often allows you to find out the true cause of pain in spondylosis.
If nerve damage is suspected, ENMG may be prescribed to determine the degree of nerve fiber damage and conduction disturbance. Sometimes, to clarify the diagnosis, a radioisotope scan may be prescribed, based on varying degrees of absorption of radioactive material by tissues with different metabolisms (for example, with inflammation or tumors, more radioisotope will accumulate abnormally in the bone tissue).

Treatment

There is currently no treatment that can reverse spondylosis because it is a degenerative process. Treatment of spondylosis is to treat symptoms such as pain in the lower back or neck and is similar to that in the treatment of degenerative disc disease.

Medical treatment. There are no medications that reliably stop the degenerative process in the spine. In pain syndrome, as a rule, drugs of the NSAID group and muscle relaxants are widely used. Non-steroidal anti-inflammatory drugs can be very effective in relieving back and neck pain associated with spondylosis (ibuprofen, movalis, naproxen). Muscle relaxants such as cyclobenzaprine (Flexeril) and tizanidine (Zanaflex) have been shown to significantly reduce muscle spasm associated with spondylosis. For severe pain, analgesics such as tramatodol or drugs of the narcotic group can be used.
Antidepressants may be used for chronic pain. Medicines called tricyclic antidepressants, including amitriptyline (Elavil) and doxepin (Sinevkan), have been used for many years in low doses to treat chronic back pain. Recently, an antidepressant such as duloxetine (Cymbalta) has been used, and its effectiveness in chronic back pain has been reliably proven. A good effect is the use of ointments containing capsaicin.

Physiotherapy helps reduce pain, improve microcirculation in the tissues of the spine.

LFK . A carefully selected program of exercises both with weights (on simulators) and in the form of gymnastics (qigong or yoga) can also reduce both pain manifestations and improve the functionality of the spine.

Manual Therapy Gentle manual therapy techniques achieve mobilization of the motor segments and reduce pain. However, some patients should not be subjected to manual manipulation, especially when spondylosis is combined with a disease such as ankylosing spondylitis.

Acupuncture reduces pain and improves conduction along nerve fibers.

Minimally invasive procedures, such as injecting steroids into the epidural space or into joints or injecting into trigger points, can also reduce pain.