Osteoarthritis in the Spine

1st July 2007 at 09:23 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article discusses various aspects of osteoarthritis in the spine.

Osteoarthritis in the Spine

Introduction

Osteoarthritis is a type of arthritis caused by the breakdown and loss of cartilage of a joint. Also known as degenerative arthritis, osteoarthritis commonly affects the hands, feet, spine and large weight-bearing joints, such as the hips and knees.

Spinal Osteoarthritis

Osteoarthritis of the spine is known as spondylosis or spondylitis. It can develop in the joints that connect the upper part of the spine as well as in the joints of the spine itself. Spondylosis or spinal osteoarthritis is a degenerative disorder that might lead to a loss of normal spinal structure and function. The degenerative process involved in this condition may affect the following regions:

• Cervical (neck)
• Thoracic (mid-back)
• Lumbar (low back)

Impact of Spinal Osteoarthritis

Osteoarthritis of the spine or spondylosis affects different regions in the body in varied ways. In this section, we have explained how spondylosis affects the various spinal elements.

1) Intervertebral Discs

The biochemical changes occurring with age affect the tissue found through out the body. The structure of the intervertebral discs in the spine might be strongly effected to due to this phenomenon. These include the annulus fibrosus, lamellae and nucleus pulposus. The annulus fibrosus is composed of 60 or more concrete bands of collagen fiber termed lamellae. Meanwhile, the nucleus pulposus is a gel-like substance inside the intervetebral disc encased by the annulus fibrosus.

2) Facet Joints

Each vertebral body has four facet joints that work like hinges, also termed as the zygapophyseal joints. These are the articulating joints of the spine that enable extension, flexion and rotation. The bony articulating surfaces are coated with cartilage, which is a special type of self-lubricating and low-friction gliding surface. The facet joint degeneration causes loss of cartilage and formation of osteophytes, which further lead to osteoarthritis.

3) Bones and Ligaments

Osteophytes or bone spurs may get formed adjacent to the end plates, which might further compromise blood supply to the vertebrae. In additions, the end plates might also stiffen due to sclerosis, a thickening or hardening of the bone under the end pates. Ligaments are bands of fibrous tissue connecting spinal structures and protect against the extremes of motion. However, degenerative changes may cause ligaments to lose some of their strength.

Symptoms of Spinal Osteoarthritis

The symptoms of spondylosis vary in accordance with the different spinal levels. Here we list some of the main symptoms associated with the various spinal levels.

a) Cervical (Neck)

Neck pain from spondylosis is common and may present the following symptoms:

• Pain may spread into the shoulder or down the arm
• Weakness might be felt in the arm
• Bone spurs might form at the front of the cervical spine, causing difficulty in swallowing (dysphasia)

b) Thoracic (Mid-Back)

Pain associated with osteoarthritis is often triggered by forward flexion and hyperextension. In the thoracic spine, disc pain may be caused by flexion-facet pain by hyperextension.

c) Lumbar (Low Back)

Spondylosis affects the lumbar spine mostly in people over the age of 40. Pain and morning stiffness are common symptoms.

Treatment of Spinal Osteoarthritis

Treatment modalities for the spinal osteoarthritis are aimed at alleviating the pain, optimizing joint function and limiting the deterioration in the joints. In fact, research shows that there might not be an absolute and permanent cure for this condition. Here we briefly discuss the main treatment methods possible for relief from the symptoms of osteoarthritis of the spine.

1. Medication - Medication is basically administered for reducing inflammation, pain and stiffness. All of the NSAIDs have analgesic and anti-inflammatory properties for such purposes. Creams and gels containing NSAIDs are also available, which can be rubbed into the joints.
2. Steroid Injections – Usually given into the knee or the spine, steroid injections are an effective way of reducing pain and swelling associated with arthritis. Such injections are normally effective for a duration for one to four weeks. Meanwhile, injection of a drug known as hyaluronic acid into the knee can reduce pain for a period of 6 months.
3. Lifestyle measures – There are a vast series of lifestyle measures that can be adopted in the condition of spinal osteoarthritis. The main amongst these include:
   • Weight reduction
   • Less consumption of alcohol
   • Smoking cessation
   • Adequate sleep
   • Minimizing fatigue

4. Exercise - Apart from maintaining a healthy lifestyle, it is also important to maintain a regular regimen for exercise. Individuals suffering from the osteoarthritis of the spine should carefully plan an exercise regimen in proper consultation with the healthcare provider and a physiotherapist.
5. Surgery – Two types of surgical techniques can normally be performed for the treatment of osteoarthritis. The first is to replace a hip or knee joint with artificial one, also known as prosthesis. The second option is to fuse the joints in the spine.

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