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Osteoarthritis of the Spine

Osteoarthritis of the spine is a degenerative disease affecting the facet joints (spinal joints). Osteoarthritis usually doesn't begin until after the age of 45 and is the most common after the age of 60, but may occur at any age.

*Osteoarthritis is not to be confused with osteoporosis, in which the bones gradually become porous and brittle.

Degenerative changes in the spine (in the facet joints and discs) are commonly referred to as spondylosis. Though disc degeneration is a separate process from facet joint degeneration (spinal osteoarthritis), disc degeneration is almost always seen in people with osteoarthritis of the spine.

*Spondylosis is not to be confused with spondylolysis, which is a type of fracture of a part of a vertebra that may or may not lead to spondylolisthesis (slippage of the cracked vertebra over the one below it).

Osteoarthritis is a degeneration of the cartilage coating the ends of the bones in a joint. The spine, the hips, knees, hands or are common locations for osteoarthritis. In spinal osteoarthritis, the smooth articular cartilage coating the facet joints of the spine gradually deteriorates. The bones of the joints can't move smoothly over roughened cartilage, causing irritation and damage to the bone. Bone spurs may form.

Degeneration is usually seen in the discs between the vertebrae (though disc degeneration is a separate condition). Disc degeneration is believed to contribute to the development of spinal osteoarthritis as the discs lose their ability to absorb shock and protect the spinal joints from wear and tear.

There is not usually any inflammation in the early stages of osteoarthritis of the spine. In advanced cases, bits of cartilage may break off and float around inside the joints. This can cause irritation to the soft tissues and inflammation may result. An x-ray can help determine if there are bone spurs or damage to the bones.

There are varying degrees of damage in spinal osteoarthritis, from mild cases without symptoms or with mild back pain, to advanced cases where the bones of the joints rub together. The amount of back pain does not always correlate with the damage to the spine. Symptoms may come and go for no apparent reason.

Spinal osteoarthritis can affect different areas of the spine. The locations can vary from person to person.

The lower back (lumbar spine) is the most common location for spinal osteoarthritis. This is not surprising since the lower back carries most of the weight of the body and is the area of the body that is subject to the most mechanical stress. Excess stress on the lower back can cause back muscle strain as well as irritate spinal joints already damaged by osteoarthritis.

The neck is also a common area for pain due to osteoarthritis and holding the neck in one position too long can trigger pain.

With osteoarthritis in the upper back, pain may flare up from slouching.

It is difficult to differentiate joint pain from muscle pain. Poor posture or holding one position too long can aggravate spinal osteoarthritis but is also a very common cause of back and neck muscle strain.

 

Symptoms

Back pain and/or neck pain and stiffness, especially for the first half hour in the morning. The symptoms typically improve during the day and worsen late in the day. In the early stages there may be no symptoms. Many people reduce their activity because of back pain or because they believe it will worsen spinal osteoarthritis. As a result, the muscles that support the back become weaker and more stress is placed on the spinal joints.

Advanced cases of spinal osteoarthritis may result in spinal stenosis. Spinal stenosis is a compression of the spinal cord and/or nerve roots due to narrowing of the spinal canal. Inflammation may occur in advanced osteoarthritis, causing a narrowing of the spinal canal. Bone spurs may also form on the spinal joints, reducing the size of the openings in the vertebrae and compressing the spinal nerve roots. Pressure on nerve roots may cause pain, numbness, tingling, or weakness. See Spinal Stenosis for more information.

In advanced osteoarthritis involving the neck area pressure on nerve roots can result in muscle weakness, pain and/or numbness/tingling in the shoulders or arms. There may be a loss of balance, headaches at the back of the head, and neck pain/stiffness. In advanced osteoarthritis of the lower back if bone spurs put pressure on nerve roots, pain and/or weakness/tingling/numbness in the legs, buttocks, and sometimes feet may occur.

 

Treatment

Exercise

Strengthening Exercises to strengthen the back and abs are helpful. Strong muscles help support the spine, absorbing shock before it reaches the joints of the spine. Stretching exercises can decrease stiffness and ease back pain. Consult your physician before starting an exercise program. See Back Exercises for more information.

Low-impact aerobics such as walking, swimming, or using an exercise bike or elliptical trainer increase circulation and decrease stiffness without placing undue stress on the spinal joints. Aerobics also help in keeping one's weight down. Keeping weight under control helps as excess weight causes extra stress on the joints.

Warm Water Exercises: Water supports the majority of body weight, taking stress off the joints. Exercising in warm water has extra benefits - warm water increases circulation, eases pain and loosens up stiff muscles and joints, which make exercises easier to perform. Many public swimming pools offer exercise classes for those with osteoarthritis.

Heat

*Do not apply heat to an inflamed area. Heat increases inflammation.

Apply heat for 20 - 30 minutes at a time, waiting at least an hour between each application to prevent overheating of tissues. Moist heat penetrates the tissues more quickly, and penetrates more deeply than dry heat.

*Do not use rubs and heat at the same time as a burn may occur.

Cold

Ice wrapped in a cloth can be applied after exercise if back pain flares up. (Don't leave ice on for over 20 minutes to avoid frostbite). Ice may be reapplied every one to four hours. Applying a wet towel between the skin and the ice pack will allow the cold to penetrate more deeply. If back pain continues over a couple of days, take a break from exercising. Resume exercising once the pain has subsided. If back pain doesn't subside over a few days, consult your doctor.

Analgesics

Analgesics such as Tylenol or anti-inflammatory such as Aspirin are good for minor pain. Aspirin is also an anti-inflammatory. Taking an anti-inflammatory medication may be helpful. Sometimes taking an anti-inflammatory before exercise can help prevent or reduce post-exercise pain. Consult your doctor on the use of anti-inflammatory medications. Over use of anti-inflammatory medications may cause stomach ulcers, so don't overdo it. See Osteoarthritis Medications page.

Supplements

Glucosamine and Chondroitin, MSM, and omega-3 fatty acids are commonly used supplements for the pain and inflammation of osteoarthritis. See Osteoarthritis Supplements page.

Topical Rubs

Deep-Heating rubs applied to the skin can relieve back pain by increasing blood flow to the area. This causes a sensation of warmth, which is both soothing and a distraction from the pain.
Topical capsaicin cream: Capsaicin is an extract from red chili peppers that reduces a substance in the nerve endings that transmit pain to the brain. It can take several weeks to obtain the full effect.

Topical Medications

Some prescription topical creams contain an NSAID that is absorbed through your skin directly to the area where it is needed. This minimizes the amount of drug that gets into the bloodstream and lessens the chance of side effects from the medication. If you are taking oral NSAID's for spinal osteoarthritis you may have to reduce the dosage of your medication.

Adequate Back Support

A medium-firm mattress can be helpful, especially if the pain is in the lower back. Too soft of a mattress causes the lower back to sink into the mattress and can irritate the spinal joints; too firm of a mattress can cause pressure points, and reduce circulation. There needs to be enough cushioning to let your body sink into it a bit and to distribute your weight evenly. A good quality piece of foam placed on top of a mattress can help.

Having a chair that reclines slightly shifts your weight onto the backrest of the chair, which takes some of the pressure off of the discs and spinal joints and allows your back muscles to relax.

Invasive Treatments:

Spinal Injections

Spinal injections are sometimes used when pain does not respond to non-invasive treatments. A mixture of a corticosteroid (a powerful anti-inflammatory) and a local anesthetic is used in spinal injections. Many people experience relief from one injection, others may need up to three. Results vary widely with many people receiving relief that lasts from a few weeks to a few months. The injection is sometimes ineffective in relieving pain. There are rare but serious risks involved.

Facet Joint Injections
In moderate to advanced arthritis, where inflammation is causing severe pain and restricted mobility, injections of corticosteroids into the affected facet joints (spinal joints) may be given. Some people experience relief that lasts up to three months, though results vary widely.

Epidural Steroid Injection (ESI)
An injection into the epidural space - the narrow space between the membranes covering spinal cord and the wall of the spinal canal. The medication travels up and down the epidural space to coat the facet joints and the spinal nerves near the area of the injection.

An epidural steroid injection can reduce inflammation of the spinal joints (facet joints) and also relieve pain caused by compression or irritation of spinal nerves. Advanced osteoarthritis may cause narrowing of the spinal canal and compress nerve roots. Nerve irritation may result in burning or shooting pain that may radiate down a leg or arm when a nerve in the lower spine or neck is compressed.

See Spinal Injections page for more info.

Surgery

Conservative treatments usually relieve the symptoms of spinal osteoarthritis. When surgery is performed, it is almost always elective surgery. Emergency surgery, though rare, may be needed if there is severe neurological impairment (great difficulty in walking or there is a sudden loss of bladder or bowel function) due to severe compression of the spinal cord or nerve roots. See Spinal Stenosis.

Surgery may be performed to remove bone spurs, shave damaged cartilage, etc. Sometimes this can be accomplished with arthroscopic surgery. Arthroscopic surgery is non-invasive surgery where a camera attached to video monitor is inserted through a small incision. It is usually performed on an outpatient basis.

Fusing the vertebrae together to stabilize the neck is sometimes done in severe cases of cervical spondylosis.

Complementary Treatments

There are many complementary treatments for used to reduce pain. These treatments are used in addition to standard medical treatments, not in place of them. Not all people will have the same results with any treatment (standard or complementary) -even people with the same condition. Acupuncture and massage therapy are examples of popular complementary treatments.

Fortunately, the majority of cases of spinal osteoarthritis are mild and do not lead to serious complications. There are many causes of back pain. Never attempt to diagnose yourself. Always seek a proper diagnosis from a qualified physician.