Spondylosis

Symptoms Of Spondylosis 

Age related wear and tear of the spine's intervertebral discs and joints cause a degenerative disease of the spine known as Spondylosis. There are two types of spondylosis based on the area affected:

Cervical spondylosis - affects the intervertebral discs and joints of the neck region, more precisely the first seven vertebrae of the spine. The symptoms of cervical spondylosis are as follows:

• Pain and stiffness of the neck
• Radiating or sharp shooting pain in the upper limbs
• Tingling and/or numbness in the upper limbs
• Dizziness
• Vertigo or sensation of feeling off-balance
• Grinding noise in the neck when the neck is turned sideways

Lumbar spondylosis - affects the intervertebral discs and joints of the lower spine. It mostlt affects the last five vertebrae of the spin and the sacrum bone. The symptoms of lumbar spondylosis are as follows:

• Pain and stiffness of the lower back
• Radiating or sharp shooting pain in the lower limbs and buttocks
• Tingling and/or numbness in the lower limbs
• Inability to stand or walk for longer durations
• Problems in Balancing the body

Causes Of Spondylosis

There are a few factors that are responsible for developing spondylosis, such as: 

1. Age-related degenerative changes

With age, our human body experiences wear and tear of the joints, cartilages, ligaments, and other soft tissues. These degenerative changes occur in the spine as well in the form of desiccation or drying up of the gel present in the intervertebral discs, rendering them stiff. These changes can also cause the formation of osteophytes (which are extra bony protrusions), leading to pain and stiffness.

When the spinal cord is affected due to the reduced disc space, compression of the joints and osteophytes, neurological symptoms are also seen.

2. Heredity

Genetic factors are likely to influence the formation of osteophytes and degeneration of discs. This is likely attributed to polymorphism (changes in two or more variants of a gene sequence) in genes, causing inflammation in the joints.

3. Lifestyle and environmental factors

A poor posture, lack of exercise, and obesity can fasten wear and tear of joints and thereby cause spondylosis. Occupational hazards involving lifting heavy weights or any history of trauma to the spine, can also lead to spondylosis.

Risk Factors For Spondylosis

Spondylosis is very common as age progresses. There are certain risk factors that may predispose you to develop spondylosis. These are:

1. Age above 50

2. Female gender

3. History of trauma/injury to the spine/neck

4. History of heavy weight lifting

5. Poor posture

6. Lack of exercise

7. Smoking

8. High intensity athletic activities

Diagnosis Of Spondylosis

Following evaluations are performed by the doctor to confirm the diagnosis of spondylosis: 

1. History and physical examination

The doctor will require all the details related to any past experience of the onset of your symptoms. Thorough, physical examination may also be required to check joint stiffness, muscle spasms, muscle strength. The doctor may also conduct a neurological exam to evaluate the spine.

2. Imaging studies

• X-Ray cervical spine AP & lateral - to study the abnormalities, such as bone spurs, that indicate cervical spondylosis.

• X-Ray lumbar spine AP & lateral - to study the bony changes in the lower back.

• MRI screening of whole spine - to evaluate in details of soft tissues such as cartilage, nerve roots, muscles, spinal cord, and disks. This test can show spinal compression or herniated disk more clearly than X-rays. An MRI can help identify the source and location of pain.

• CT scan spine - to rule out other possible causes of neurological symptoms like vertigo, headaches, etc.

• CT myelography - to study whether the spinal cord is affected, if yes then to what extent. These tests provide more details on how and to what extent cervical spondylosis may be affecting your nerves.

• Bone densitometry whole body - to check for concomitant osteoporosis, a condition where the bones lack calcium and become brittle and weak.

3. Other tests

• Serum calcium - to check for calcium deficiency which plays an important role in bone and joint pains.

• Vitamin D (25 - OH) - to check for calcium deficiency which plays an important role in absorbing calcium in the body.

• Nerve compression studies - NCV Upper Limb and NCV lower limb for cervical and lumbar spondylosis, respectively. These help to evaluate nerve damage when symptoms, such as tingling and radiating pain, are present. 

• Electromyography - measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.

Prevention Of Spondylosis

While spondylosis is an age-related condition that occurs as a result of degenerative changes and wear and tear of the spine, a few things can help prevent the occurrence of serious symptoms of spondylosis, such as: 

• Following a healthy diet rich in calcium, Vitamin D, and other minerals.
• Enough exposure to the morning sunlight to ensure a sufficient level of Vitamin D in the body.
• Regular exercise to maintain strength and mobility in the cervical and lumbar spine.
• Avoiding routine heavy weight lifting.
• Following correct ergonomics during weight lifting.
• Avoiding sudden jerky and twisting movements of the spine.

Specialist To Visit

When symptoms of neck pain or back pain start becoming bothersome, it is essential to seek medical care. The doctors who can help with spondylosis symptoms include -

• Orthopedician
• Neurologist
• Physiotherapist 

Orthopedicians focus on reparing injuries to musculoskeletal sysytem of the spine including bones, joints, ligaments and tendons. Neurologists can help you manage neurological symptoms, such as tingling, numbness in the upper or lower limbs, weakness of upper or lower limbs, vertigo, and headaches. A physiotherapist can help with corrective exercises to increase strength and mobility in the spine and reduce pain.

Treatment of Spondylosis

The primary aim of the treatment of spondylosis is to provide pain relief and address other troublesome symptoms. Following medications are useful in the treatment of cervical and lumbar spondylosis.

1. Medical management

NSAID analgesics

This class of medicines helps relieve pain and inflammation. These medicines must always be consumed with meals as taking them on an empty stomach may irritate the gastric lining. Examples include:

• Ibuprofen
• Diclofenac
• Paracetamol
  
  

Opoid Analgesics

Also known as narcotic medications, these may be required when the pain is intense and is not relieved by the first line of medication. These potentially habit-forming tablets must be taken only when prescribed by the physician. These include:

• Tramadol
• Tapentadol
  
  

Bone and joint care medications

This class of medicines help in lubrication and reducing joint friction for easier joint movements. Examples include:

• Hyaluronic acid
• Glucosamine
• Chondroitin
  
  

Muscle relaxants

These help relieve the painful spasms and stiffness associated with spondylosis. Examples include:

• Cyclobenzaprine  
• Tizanidine
• Cyclobenzaprine
• Thiocolchicoside 
  
  

Medications for nerve symptoms

These are useful in providing relief from radiating pain, tingling, and numbness in the upper and lower limbs. Examples are:

• Pregabalin
• Gabapentin
• Duloxetine
  
  

Corticosteroids

This may be prescribed for a short duration or even as an injection to address resistant pain symptoms. Medicines that belong to this class include prednisolone. A short course of oral prednisone might help ease the pain. If your pain is severe, steroid injections may be helpful. 

Here’s more on oral corticosteroids: Dos and don’ts to follow 

Vitamins and mineral supplements

Nutrients like calcium and Vitamin D play a particular important role. A walk in the morning sun would be one of the best ways to raise Vitamin D levels. Dietary intake of dairy products, fish, broccoli, kale, legumes, tofu are useful in raising calcium levels. 

Topical analgesic and rubefacients 

Topical analgesics include NSAID preparations, rubefacients, cooling therapy preparations and heat pads. Topical rubefacients presumably reduce pain by increasing local blood flow. 

2. Surgical management

Patients with advanced forms of spondylosis with very severe symptoms, who do not get relief with medications and physiotherapy, may require surgical treatment to remove the desiccated disc or other parts of the vertebrae. This will relieve compression from the spinal cord and help mobilize the intervertebral joint. If their neurological signs and symptoms such as weakness in their arms or legs worsen, they might need surgery.

The surgery might involve:

• Removing a herniated disk or bone spurs
• Removing part of a vertebra
• Fusing a segment of the neck using bone graft and hardware

Home-care For Spondylosis

Spondylosis is an age-related degenerative condition that can cause pain and stiffness in the spine. Along with the medications, the following home care tips can help manage symptoms and provide relief to some extent from the disease. 

1. Avoid lifting heavyweights.

2. Take a wholesome, balanced diet rich in calcium and other minerals.

3. Follow the exercise routine suggested by the doctor or physiotherapist.

4. Application of topical analgesic preparations helps relieve pain and stiffness.

5. Hot fomentation (method: applying moist heat to the affected area) or ice pack can also help to provide some relief.

6. Use cervical and lumbar supports, such as a cervical collar or lumbosacral belt to support the spine. This can limit neck/back movement and help strained muscles rest and recuperate. However, wearing a brace for too long can lead to muscle atrophy (wasting away). Hence, they should be worn only for a short duration.

7. Change the mattress and sleeping pillow if not proper. Use the ones that offer good support and stabilize the spine.

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Complications Of Spondylosis

In some cases, spondylosis may cause severe and irreversible neurological complications of spondylosis, such as cervical myelopathy, which causes a varying degree of weakness and disability. It can lead to paralysis, such as quadriplegia, a serious condition in which the body below the neck is paralyzed. It may also cause paraplegia, paralysis of both legs.

Surgery for spondylosis may also cause complications like nerve injury, post-surgery kyphosis or altered posture, etc.

Alternative Therapies for Spondylosis

Along with medicines and topical analgesic preparations, various other treatment options are helpful in managing spondylosis. Here is a list of options to help you manage the symptoms:

1. Exercise and yoga

Regular exercises and yoga focused on strengthening the spinal musculature and improving mobility help manage the pain and stiffness caused by spondylosis.

2. Physiotherapy

Physiotherapeutic modalities, such as Interferential Therapy (IFT), Transcutaneous Electrical Nerve Stimulation (TENS), are very useful and offer pain relief even from nerve pain. These rehabilitation exercises focus on core strengthening of the spine, improving the overall strength of the spine.

3. Acupressure and acupuncture

Neck pain and back pain due to spondylosis may respond to acupuncture or acupressure therapy on the peripheral trigger points.

4. Ayurveda

There are various Ayurvedic preparations in the form of oils and liniments such as camphor oil, menthol oil, sesame oil, etc. that can be applied locally at the site of pain. They provide relief from the symptoms.

5. Homeopathy

Homeopathic preparations, such as Rhus Toxicodendron, Calcarea Carbonica, Kalmia Latifolia, and Paris Quadrifolia, are known to improve pain and other troublesome symptoms of patients with spondylosis.

6. External orthoses support

Cervical collars and lumbosacral belts offer much-needed support to the degenerative spine and are useful in alleviating pain caused due to spondylosis. They may also help prevent or slow down further deterioration.

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Living With Spondylosis

Spondylosis can be a considerable source of worry due to constant and prolonged pain. Patients with spondylosis are often unable to enjoy an active lifestyle due to the pain and stiffness. The quality of life is highly defined by the severity of the pain and patients may become susceptible to anxiety and depression due to the nature of the disease. 

If you suffer from spondylosis, you must take adequate care of your spine to prevent further worsening. Follow all the precautions as advised by your doctor and take your medicines on time. Do not engage in activities that require you to lift weights, such as carrying large amounts of groceries, water buckets, etc. Modify your household chores so that you do not require forward bending. Exercise regularly as advised by your physiotherapist.