What is Spondylosis ?

In its simplest possible form, spondylosis can be defined as arthritis of the spine. It is a sequelae of the aging spine. Spondylosis can affect any/all regions of the spine, determining what symptoms you have. You can have spondylosis in your neck (cervical spondylosis), mid-back (thoracic spine), or low back (lumbar spondylosis).

What are the common symptoms in spondylosis ?

Neck (Cervical spine)
1) Pain that comes and goes
2) Pain that spreads into your shoulders, arms, hands, or fingers
3) Morning neck or shoulder stiffness or a limited range of motion after getting out of bed
4) Neck or shoulder tenderness or numbness
5) Weakness or tingling in your neck, shoulders, arms, hands, or fingers
6) Headache in the back of your head
7) Loss of balance
8) Difficulty swallowing (This is rare, but it may occur if the spinal cord is compressed.)

Low back (Lumbar spine)
1) Pain that comes and goes
2) Morning low back stiffness after getting out of bed
3) Pain that decreases with rest or after exercise
4) Low back tenderness or numbness
5) Sciatica (mild to intense leg pain)
6) Weakness, numbness, or tingling in the low back, legs, or feet
7) Difficulty walking

Bowel or bladder problems (This is rare, but it may occur if the spinal cord is compressed.)

What is the cause of spondylosis ?

The aetiology/cause of neck pain is multifactorial, there is no evidence to prove/disprove the quantitative effect of one or other. The risk factors for neck pain can be:

•Aging: as a part of the normal age related degenerative process.

•Life style: Stress and emotional tension, poor posture -standing for long periods of time or sitting incorrectly—can cause neck pain, heavy physical work, lifting or forceful movement, bending, or awkward positions can really hurt your neck.

•Injuries and Accidents: Injury to muscle , ligaments , or soft tissue can lead to neck pain .Fracture in spinal bone in a fall or a car accident also is a common cause.

• Obesity : along with weak abdominal muscles often disrupt the spine’s balance, causing your neck to bend uncomfortably to compensate

What is the affected anatomy in spondylosis ?

Human Spine is made of up 33 bones (vertebrae) that are cushioned by discs. These vertebrae are divided by region: neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). At the lower end spine ends at the terminal bone of sacrum and the coccyx, which is commonly called your tailbone. Discs are present between these bones. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting. Each disk has two parts – a soft, gelatinous inner portion (nucleus pulpous) and a tough outer ring (annulus fibrosis). Facet joints are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help movement and are very important for flexibility . Spondylosis that affects the joints is called osteoarthritis, which is the most common form of arthritis in the spine. These spinal joints are covered by cartilage. With erosion of the cartilage, as occurs with age, the bones rub together-this causes severe pain.

Will I need surgery for spondylosis ?

For patients diagnosed with spondylosis, the best news is that it seldom requires spine surgery. Non-surgical treatments, such as medications or physical therapy, work quite well in reducing patients’ pain levels, and those treatments are almost always tried first for several months.

However, surgery is necessary in a few scenarios:

• You have bowel or bladder dysfunction. This is rare, but it may occur with spinal cord compression.
• You have spinal stenosis, and your doctor feels that surgery is the best way to treat it.
• You are experiencing other neurologic dysfunctions, such as severe arm or leg weakness, numbness, or tingling.
• Your spine is unstable. As spondylosis affects the parts of your spine, especially your facet joints (the joints that help control the spine’s movements), your spine can develop spinal instability. An unstable spine puts you more at risk for developing neurological problems.

What are the treatment options for spondylosis ?

There are different options to treat back pain depending on the severity and duration of symptoms . They may comprise of one or many :
Drugs & Medications
Physical Therapy
Spinal Bracing
Spinal Injections
Spine surgery
Physiotherapy

Drugs, Medications, to Relieve Back Pain :

Medication alone is not the ultimate solution to your back pain, however during emergency or during severe pain these medicines may help you curb the suffering.

Acetaminophen :

Your doctor may call this an analgesic, but most of us refer to acetaminophen medications as painkillers. They don’t help reduce inflammation, though.

NSAIDs (non-steroidal anti-inflammatory drugs) :

These will help reduce swelling (or inflammation) while relieving your pain; that’s how NSAIDs differ from acetaminophen. If an over-the-counter NSAID is an option for you, you have plenty to choose from. You can use ibuprofen, aspirin; however seek medical advice before you take any medicine.

Muscle Relaxants :
If you have chronic back pain caused by muscle spasms, you may need a muscle relaxant, which will help stop the spasms

Anti-depressants :
As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they block pain messages on their way to the brain. They can also help increase your body’s production of endorphins, a natural pain killer.

Opioids : In the most extreme cases, and only under careful supervision, you doctor may also prescribe an opioid, such as morphine or codeine.

Medication Warning : As with all medications, you must follow your doctor’s advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor.

Physical Therapy to Relieve spondylosis :
(A) Passive Therapy
•Massage
•Heat Therapy /Cold /Ice Packs
•Local Ointments application
•SWD/ TENS /IFT
Traction
(B) Active Therapy – exercises
•Endurance exercises
•Strengthening exercises for back and abdominal muscles
•Core stability Exercises


Passive Treatments :

• Deep Tissue Massage :Deep tissue massage relieves deep muscle tension and spasms, which develop to prevent muscle motion at the affected area.

• Hot and Cold Therapy :
Both hot and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results. This reduces inflammation, muscle spasms and pain.

• TENS (transcutaneous electrical nerve stimulation) :
Uses electrical current to stimulate your muscles and reduces muscle spasms and is generally believed to trigger the release of endorphins, which are your body’s natural pain killers.

• Traction :Reduce the effects of gravity on the spine. the intent is to reduce the disc herniation and is usually performed in the cervical or lumbar spine.

Active Treatments :Help to reduce recurrent pain but will also benefit your overall health.

Core stability :Many people don’t realize how important a strong core is to their spinal health. Your core (abdominal) muscles help your back muscles support your spine. When your core muscles are weak, it puts extra pressure on your back muscles. Your physical therapist may teach you core stabilizing exercises to strengthen your back.

Flexibility :
Learning proper stretching and flexibility techniques will prepare you for aerobic and strength exercises. Flexibility helps your body move easier by warding off stiffness.

Muscle strengthening :Strong muscles are a great support system for your spine and better handle pain.

Spinal Injections :
Injection techniques
• Root Block Injection
• Epidural Injection
• Caudal Block Injection
• Facet Block Injection

Epidural Steroid Injection : An epidural steroid injection sends steroids—which are very strong anti-inflammatories—right to the nerve root that’s inflamed. This is a pain management therapy, so it’s best to have a well-trained pain management specialist do the injection. You’ll probably need 2-3 injections; generally, you shouldn’t have more than that because of the potential side effects of the steroids.

Spinal Bracing :

Spinal bracing utilises these primary objectives:

• Controlling back pain by limiting motion and unloading discs, vertebrae and other spinal structures by compressing the abdomen.
• Stabilising weak or injured structures by immobilising the spine.
• Providing three-point force systems to provide correction or prevent progression of a deformity.

Different type of braces are classified based on the rigidity and are – Flexible, Rigid or Semi-rigid.

• Flexible orthoses or corsets are prescribed for relief of low back pain associated with degenerative disc disorders, trauma, or postural deformities. Rigid stays and inserts can be added to restrict motion and act as a postural reminder.

• Rigid orthoses are commonly custom fabricated and provide the most support to the area being treated. A body jacket or TLSO controls motion in all planes.A two piece front and back design is commonly used post operatively for ease of application while a front or back opening single piece design is commonly utilised when treating scoliosis.

Different types are :
Corset braces
Hyperextension braces
Moulded jackets
Neck braces
Rigid braces
Sacroiliac and lumbosacral belts
Trochanteric belts
Thoracolumbosacral orthoses (TLSO)

Caution:
Long time usage of corsets / belts can lead to muscular atrophy due to disuse.
Please consult your specialist before using a corset/ belt for your spinal problem.

Surgery for Back Pain :

Only 5% of people need surgery to treat back problems. Your pain may be severe, but most sprains and strains do not require surgery. Surgery is reserved for the most severe cases of back pain (spinal cord impingement, structural deformity, severe cases of spinal stenosis)
a. Surgery- Surgery is often required for patients whose symptoms are worsening over 2-3 weeks, and patients are not responding to conservative treatment. Emergency surgery is required for patients who have lost bowel / bladder control – Cauda Equina syndrome. The options of surgery are

•Decompression
•Spinal Fusion

The spine surgery advised for Back pain can be performed in many different ways. The success rates of surgery in slip disc/ herniated disc / sciatica is 99 % and with invention of modern technology and minimal invasive surgery techniques it nears 100 %. Spine surgery can be performed in different manners;-

Conventional Open surgery
Minimal Invasive Spine surgery – Key hole spine surgery
Endoscopic Spine Surgery
Microscopic spine surgery
Micro endoscopic spine surgery

Decompression includes:

•Facetectomy :A procedure that removes a part of the facet (a bony structure in the spinal canal) to increase the space.

•Foraminotomy :A procedure that removes the bony compression over foramina (the area where the nerve roots exit the spine) to increase the size of the nerve pathway.

Laminoplasty :A procedure make more room for the spinal canal.

•Laminotomy :
A procedure that removes only a small portion of the lamina (a part of the vertebra) to relieve pressure on the nerve roots.

•Micro-discectomy :A procedure that removes a disc through a very small incision using a microscope.

Laminectomy:
A procedure for treating spinal stenosis by relieving pressure on the spinal cord.

Spinal Fusion: The surgery intends to stabilise a unstable segment responsible for pain , this may involve putting some screws in your spine to increase stability.

Various options of doing spinal fusion are PLF /PLIF/TLIF/ ALIF/XLIF

Besides fusion, there are other stabilization options:

• Interspinous Process Decompression: Your doctor may perform an interspinous process decompression using an X-Stop. An X-Stop is a special spinal implant that fits in between your spinous processes and should keep them from pinching nerves and causing pain. It should also help you maintain more spinal flexibility and range of motion.

• Dynamic Stabilization: The surgeon will attach spinal implants to the pedicles (a region of your vertebra) to provide a tension band for support. Dynesys is an example of a dynamic stabilization implant, and it may help you maintain more spinal flexibility and range of motion.

As you can tell, there are many types of surgery used for spondylosis. Your spine surgeon will recommend the best procedure to treat your particular case.