Spondylosis is a chronic degenerative lesion of the spine that develops as a result of aging, overloads or injuries of the spinal column. It is accompanied by dystrophic changes in the anterior parts of the intervertebral discs, calcification of the anterior longitudinal ligament and the formation of osteophytes in the anterior and lateral parts of the spine. It often proceeds asymptomatically, may manifest itself with intermittent pain, limited mobility, rapid fatigue during exercise and movement. The diagnosis is made based on the results of radiography, MRI and CT. Treatment is usually conservative.
ICD 10
M47 Spondylosis
Meaning
Spondylosis is a chronic disease of the spine of a degenerative–dystrophic nature. It is accompanied by local changes in the anterior parts of the intervertebral discs and the anterior longitudinal ligament. In an isolated variant (with damage to 1-2 vertebrae and the absence of other pathological changes in the spine), spondylosis usually occurs at a young or middle age, is a consequence of constant static-dynamic overloads, spinal injuries or infectious diseases and proceeds asymptomatically or with poorly expressed symptoms.
In combination with other diseases of the spine (osteochondrosis, spondyloarthrosis), spondylosis is often detected in elderly and senile people, while the most striking clinical manifestations are caused not by spondylosis, but by other degenerative-dystrophic processes. Pathological changes characteristic of spondylosis can occur at any level, but the lumbar and cervical spine are more often affected. Treatment of spondylosis is carried out by vertebrologists, orthopedists and traumatologists. In the presence of neurological manifestations, the participation of a neurologist is required.
Causes
Currently, there are two points of view on this pathology. Some specialists in the field of traumatology and orthopedics consider this process as a variant of the primary degenerative-dystrophic lesion of the spine. Others believe that the main cause of the development of spondylosis is a single injury or repeated microtrauma of the anterior longitudinal ligament when the fibrous ring of the intervertebral disc protrudes. From this point of view, spondylosis is a disease with a mixed etiology, combining the influence of both traumatic and degenerative processes.
Researchers associate spondylosis not only with injuries, but also with metabolic disorders, natural aging and wear of the anatomical structures of the spine, as well as improper distribution of the load on the spine due to scoliosis or kyphosis. As the main predisposing factors for the occurrence of this disease, experts indicate constant static overload, heavy physical labor, injuries and microtrauma of the spine, some infectious and non-infectious diseases. There is also a constitutional predisposition.
Pathanatomy
Most scientists recognize the connection between the development of spondylosis and injuries of the anterior longitudinal ligament. They describe the mechanism of development of pathological changes as follows: for some reason (injuries, overloads, infectious diseases), degenerative changes occur in the anterior parts of the intervertebral disc and the fibrous ring becomes unable to hold the pressure of the pulp core. With a significant load, the fibrous ring protrudes and tears the longitudinal ligament from the place of its attachment to the anterior surface of the vertebral body.
A small hematoma forms in the area of separation, and at some distance from the hematoma, an osteophyte begins to form under the detached ligament. With repeated injuries, accompanied by new partial tears of the ligament, new osteophytes arise. At the same time, unlike osteochondrosis or intervertebral herniation, there is no change in height or pronounced dysfunction of the intervertebral disc, so spondylosis is asymptomatic for a long time.
Osteophytes irritate the anterior longitudinal ligament, and when they grow along the edges of the vertebrae, they limit the mobility of the spine. With a prolonged course of spondylosis, bone outgrowths can reach large sizes and connect with each other, which leads to fusion of the bodies of neighboring vertebrae. Over time, the proliferation of osteophytes sometimes causes narrowing of the intervertebral openings and the spinal canal. This causes pain syndrome and the development of neurological disorders.
Researchers associate spondylosis not only with injuries, but also with metabolic disorders, natural aging and wear of the anatomical structures of the spine, as well as improper distribution of the load on the spine due to kyphosis or scoliosis. As the main predisposing factors for the occurrence of this disease, experts indicate constant static overload, heavy physical labor, injuries and microtrauma of the spine, some infectious and non-infectious diseases. There is also a constitutional predisposition.
Spondylosis symptoms
In some cases, the pathology is asymptomatic and becomes an accidental finding during spine x-ray for other injuries or diseases. There may be some limitation of the mobility of the affected spine, not accompanied by other symptoms. Typical manifestations of spondylosis are heaviness in the spine and dull aching local pains that intensify by the end of the day. Pain can cause anxiety at night, occur not only when moving, but also at rest.
Patients with spondylosis for a long time can not find a comfortable position of the head (with cervical spondylosis) or the trunk (with thoracic and lumbar spondylosis). The tension of the long muscles of the back and stiffness of movements are noted. Even if there is no pain at the moment, patients tend to make head or trunk movements slowly and with some effort. When the nerve roots are compressed, neurological disorders may occur. Pain syndrome and neurological disorders are provoked by significant physical exertion, sudden movements or hypothermia.
It should be borne in mind that with spondylosis there is no clear correlation between the severity of pathological changes in the affected vertebrae and the clinical manifestations of the disease. With gross changes on radiographs, only minor symptoms can be detected that do not cause the patient much concern and do not violate his ability to work. Spondylosis is characterized by a very slow progression, in the absence of other spinal diseases, clinical manifestations may not worsen for decades.
- Cervical spondylosis is more often found in people 40-50 years old who are engaged in intellectual work and, as a result, are forced to stay in a forced position for a long time – sitting at a table with their torso tilted forward. Usually the V and VI cervical vertebrae are affected. With cervical spondylosis, there may be cervical migraine and neck pain, sometimes radiating into the arm or shoulder blade. There is a restriction of movements when turning the head, more noticeable in the standing position. In the supine position, stiffness, as a rule, decreases. Visual disturbances, ringing or tinnitus and changes in blood pressure are also possible. When palpating the vertebrae, muscle tension is determined, pain may occur, which increases when the head is tilted back.
- Spondylosis of the thoracic spine is quite rare. The lower and middle thoracic vertebrae are mainly affected. Patients suffering from thoracic spondylosis may be concerned about pain in the affected area, sometimes unilateral. With compression of the spinal nerves, pain radiates into the chest and sternum. Palpation reveals the tension of the long muscles of the back and local areas of soreness along the spine.
- Spondylosis of the lumbar spine is detected more often than lesions of the thoracic spine. Both people of physical labor and specialists engaged in sedentary work can suffer. The defeat of the IV and V lumbar vertebrae is characteristic. With the proliferation of osteophytes, usually there is not compression, but irritation of the nerve roots with the development of the corresponding root symptoms. In patients with lumbar spondylosis, a symptom of false intermittent lameness may be detected, accompanied by a feeling of “wadded legs”, “numbness” or “rigor” of the legs with prolonged walking or static load. Unlike true intermittent lameness caused by obliterating endarteritis, with spondylosis, symptoms disappear during the forward tilt of the trunk.
Diagnostics
The main method of instrumental diagnosis of spondylosis is radiography of the spine. On radiographs, osteophytes are revealed in the form of beak-like protrusions or pointings. Minor spondylosis is accompanied by the formation of marginal osteophytes located within the plane of the site of the vertebral body along its anterior, anterolateral or lateral surface. With pronounced spondylosis, osteophytes go beyond the site and can bend around the intervertebral disc. With the counter-growth of two osteophytes located on adjacent vertebrae, the formation of neoarthrosis is possible. Pronounced spondylosis is accompanied by the formation of a bone brace that connects the bodies of neighboring vertebrae and completely blocks movement in the affected segment.
The differential diagnosis is carried out on the basis of a clinical and radiological picture. In osteochondrosis, unlike spondylosis, there is pain during palpation of the spinous processes of the vertebrae. The X-rays show osteophytes located perpendicular to the axis of the spine, there are no splices of osteophytes. In Forestier’s disease, as in spondylosis, ossification is observed in the anterior longitudinal ligament, but the process is extensive, widespread, involving three or more vertebrae. Bekhterev’s disease is characterized by a relationship with gender and age (usually develops in men 20-40 years old), an increase in ESR, subfebrility and early ankylosing of the sacroiliac joints are detected.
In favor of spondylosis, there is a lesion of no more than 1-2 motor segments (3 segments sometimes suffer in the lumbar region), the absence or slight severity of pain syndrome with significant ossification of the anterior longitudinal ligament, as well as the preservation of the height of the intervertebral discs. Spondylosis is characterized by asymmetrically arranged osteophytes of irregular shape, directed down and up and enveloping the intervertebral disc. A “counter” ossification may be detected (a symptom of the “parrot’s beak”).
Spondylosis treatment
Treatment is usually carried out on an outpatient basis. The aim of therapy is to prevent the progression of the disease, eliminate inflammation and pain syndrome and strengthen the muscular corset. The patient is recommended a reasonable motor regime with limited physical activity and the exception of a long stay in a forced position. When working sedentary, you should constantly monitor your posture and regularly change your posture, leaning back in your chair, relaxing your arms and raising your head.
With severe inflammation and pain, NSAIDs are used (meloxicam, ketoprofen, diclofenac, indomethacin, ibuprofen), physiotherapy procedures are prescribed (ultrasound, diadynamic currents, electrophoresis with novocaine). In some cases, paravertebral blockades are performed and analgesics are prescribed intramuscularly. It should be borne in mind that the listed drugs and physiotherapy eliminate the symptoms, but do not stop the progression of the disease.
The main therapeutic and prophylactic agents for spondylosis are exercise therapy and massage. Physical therapy classes begin after the pain is eliminated. Regular exercise makes it possible to improve blood circulation of muscles and spine, reduce the load on the spine by forming a muscular corset and develop correct motor stereotypes to avoid overloads of the affected segment. It should be borne in mind that with spondylosis, intensive massage, spinal traction, manual therapy and exercises aimed at mobilizing the spine are contraindicated. The prognosis is favorable.