Spondylosis Treatment Options

The term spondylosis (also called degenerative spondylosis) is not used to describe a specific problem with the spine, but rather an overall condition. Broadly speaking, a diagnosis of spondylosis means that some components of the spine are wearing down through normal, everyday use. This places spondylosis more into the category of “mechanical wear and tear,” and not that of disease or injury.

What causes spondylosis?

The spine is made up of a sandwiched stack of bony vertebrae and tough, flexible discs, connected by tiny facet joints and ligaments. All of these pieces are subject to showing signs of spondylosis.

For example, spinal discs lose water and proteins as they age, resulting in a loss of flexibility and an increased susceptibility to tears and herniations. Ligaments may tear, joints may crack, or vertebrae may grow bone spurs or grind against each other—again, all through the natural march of time and use.

Who can get spondylosis?

It is estimated that four out of five people (80%) over the age of 40 have some spinal degeneration. However, not everyone will require medical intervention to address their spondylosis.

Spinal problems caused by spondylosis

Because it is a degenerative disease, there are no standard treatments or medications for spondylosis. However, the degraded discs and bones common to spondylosis may result in a number of conditions, most of which may be treated successfully.

Among the common problems caused by spondylosis are the following:

• Bone spurs. When discs degrade and the space between vertebrae decreases, the resulting bone-on-bone friction can cause extra bone to grow on the tops and bottoms of vertebrae. Bone spurs may project into the spinal canal, contributing to spinal stenosis and nerve compression.

• Disc herniation. If a damaged disc develops a split in its outer wall, the gel-like substance on the inside can push through its container, creating a bulge. This bulging disc may press into the surrounding spinal canal and push against a nerve. This is often referred to as a “slipped disc” or “herniated disc.” Disc herniations can result in nerve pain, numbness, and tingling.

• Loss of the cushioning between vertebrae can lead to bone spurs, as described above, and osteoarthritis of the facet joints of the spine. With arthritis, the main symptoms will be pain and stiffness.

• Pinched / inflamed / compressed nerves. Herniated (bulging) or slipped discs can put pressure on nerves running through the spinal canal, resulting in:
  
  
  • When the disc (or something else, like a tumor or bone spur) presses against a nerve root anywhere along the spine.
  • Sciatica. When the disc presses on nerve roots near the base of the spine, creating symptoms in the legs and feet.
  • Myelopathy: When the herniated disc presses on the spinal cord itself, creating a spinal cord injury.
  • Stenosis. Discs may press up on the holes (foramina) in the vertebrae, creating a narrowing of that space (called a stenosis), which can put pressure on the nerves running through the vertebrae. Spinal stenosis, a narrowing of the spinal canal due to any number of factors (including bone spurs or slipped discs), can also lead to pinched nerves.

• Pinched or inflamed ligaments. Herniated discs can press on ligaments much the way they press on nerves. This can cause pain and inflammation.

Treatments for the pain caused by spondylosis

No known medicine or procedure can reverse the degradation that characterizes spondylosis. Therefore, the treatment will be to treat the resulting conditions, the primary of which will be neck and back pain.

Medical professionals generally will recommend trying every treatment other than surgery. Studies have revealed that non-surgical treatments are statistically just as effective as surgery, plus the fact that many patients continue to suffer from chronic back pain even after undergoing a surgical procedure.

• Pain medications. Both over the counter (OTC) and prescription medications are available as appropriate.
  
  
  • Medicines like acetaminophen (Tylenol) can relieve pain not caused by inflammation.
  • Non-steroidal anti-inflammatory drugs like ibuprofen (Motrin) and naproxen (Aleve) target pain caused by inflammation.
  • Severe pain may be treated with opiod-based medicine such as Vicodin or Norco. These are only available via prescription.
  • Muscle relaxants. For those suffering from painful muscle spasms caused by spondylosis, prescription medications such as cyclobenzaprine (Flexeril) and tizanidine (Zanaflex) are available.
  • Some sufferers of chronic back pain caused may benefit from the use of low doses of the antidepressants tricyclic antidepressants, including amitriptyline (Elavil), doxepin (Sinequan), and duloxetine (Cymbalta).

• Home care. The pain typically caused by spondylosis is inconsistent: it may improve or even vanish after a few days, or may reappear with rest. The following home remedies may be helpful:
  
  
  • Resume normal activities.
  • Avoid excessive bed rest, as this appears to prolong the symptoms.
  • Avoid placing unnecessary stress on the neck and back, such as those caused by heavy lifting.
  • Heat treatments, in the form of warm compresses, can relax and ease pain caused by muscle spasms.
  • Cold therapy, such as ice packs, can ease inflammation and swelling.

• Physical therapy and exercise. If spondylosis-related pain does not resolve after three or four weeks, it can be helpful to strengthen the muscles of the back and abdomen.
  
  
  • Physical therapists will assign specific exercises that are designed to strengthen those core muscles. This in turn can provide better support for the spine, which may ease the pain of spondylosis.
  • Regular mild exercise (walking) and stretching (yoga) are also beneficial for addressing chronic back and neck pain.
  • Avoid lifting heavy weights, excessive repetition, and addressing muscles that will not strengthen your core abdominal and back muscles.

• Alternative therapy. Several non-medical therapies are available to those suffering from the back and neck pain of spondylosis. While some have found them to be effective, there exists no medical evidence to their reliability or safety. These therapies should be used with caution.
  
  
  • Chiropracty/spinal manipulation. This practice revolves around pushing, pulling, and otherwise moving the bones of the spine from the outside, without using surgery. The procedures are acknowledged to provide only temporary relief, and frequent repeat visits are often scheduled.
    
    
    • Chiropractors should not attempt these procedures on patients with any kind of inflammatory conditions, such as ankylosing spondylitis or rheumatoid arthritis.
    • Nor should patients with bone abnormalities, including osteoporosis or bone spurs, undergo chiropracty, as the chances of suffering vertebral fractures is significantly higher than in people with normal, unaffected spines.
  • Based on thousands of years of Chinese medicine, acupuncture practitioners poke hair-thin needles into “trigger points,” which are believed to release stress and provide pain relief.

• Steroid injections. This procedure injects cortisone, a steroid that prevents the release of inflammation-causing substances. Depending on the location of the problem resulting from spondylosis, cortisone may be injected into:
  
  
  • The epidural space (the very small space around the spinal cord). This is also called an epidural injection.
  • The facet joints, which connect pairs of vertebra.
  • The intervertebral disc spaces, in between discs and vertebra.
  • Directly into a damaged or herniated disc.
  • The sacroiliac joint, located at the bottom of the spine, between the spine and hip.

• As mentioned above, surgery is not necessarily considered to be the best option for any type of spondylosis. The only times it should be considered are when the spondylosis is causing severe or worsening nerve damage, progressive neurological problems, or difficulty walking.
  
  In addition to collapsing or herniated discs and worn, grinding vertebrae, unwanted bone spurs may grow off of the vertebrae, resulting in narrowed openings for spinal nerves. The spurs may even press painfully into the spinal cord itself. Surgical options to alleviate such issues include:
  
  
  • Laminectomy. This procedure removes a bony portion of a vertebral arch, opening up more space for the spinal canal and relieving pressure on the spinal cord or nerves being caused by a degenerated or damaged vertebra.
  • The partial or complete removal of a damaged or degenerated disc, again relieving pressure on the spinal cord or nerve roots.
  • Foraminotomy/Foraminectomy. A procedure to expand the natural exit holes for spinal nerve roots to exit the spinal canal. The narrowing of those openings is a condition called foraminal stenosis.
  • Osteophyte removal. The formal name for cutting or shaving bone spurs off of their vertebral source bones, restoring the normal spacing between spinal bones.
  • The complete removal of one or more vertebra and one or more discs.
  • Spinal fusion. To restore stability to the spine after any of these procedures, various pieces of hardware will be used to literally fuse two or more vertebrae into a single unit.

Although the vast majority of people over the age of 40 will have some measure of spondylosis in their spines, a large number of them will never feel any symptoms. Only a relative few will develop chronic pain that will require any kind of treatment, let alone serious, complicated procedures.

Please contact Coastal Orthopedics today to discuss your Spondylosis Treatment Options at (361) 994-1166.

Article written by: Rob Williams, MD