Spondylosis

Age-related wear and tear of the spine's intervertebral discs and joints cause a degenerative disease of the spine known as Spondylosis. There are two types of spondylosis based on the area affected:

Cervical Spondylosis

Affects the intervertebral discs and joints of the neck region, specifically the first seven vertebrae of the spine. The symptoms of cervical spondylosis include:

• Pain and stiffness of the neck
• Radiating or sharp shooting pain in the upper limbs
• Tingling and/or numbness in the upper limbs
• Dizziness
• Vertigo or sensation of feeling off-balance
• Grinding noise in the neck when turned sideways

Lumbar Spondylosis

Affects the intervertebral discs and joints of the lower spine, primarily impacting the last five vertebrae of the spine and the sacrum bone. The symptoms of lumbar spondylosis include:

• Pain and stiffness of the lower back
• Radiating or sharp shooting pain in the lower limbs and buttocks
• Tingling and/or numbness in the lower limbs
• Inability to stand or walk for extended durations
• Problems with balancing the body

There are several factors responsible for the development of spondylosis:

• Age-related degenerative changes: With age, the human body experiences wear and tear of the joints, cartilages, ligaments, and other soft tissues. These degenerative changes occur in the spine, manifesting as desiccation or drying of the gel in the intervertebral discs, which renders them stiff. These changes can also lead to the formation of osteophytes (extra bony protrusions), resulting in pain and stiffness. When the spinal cord is affected due to reduced disc space, compression of the joints, and osteophytes, neurological symptoms may also be observed.
• Heredity: Genetic factors are likely to influence the formation of osteophytes and degeneration of discs. This is attributed to polymorphism (changes in two or more variants of a gene sequence) in genes, which can cause inflammation in the joints.
• Lifestyle and environmental factors: Poor posture, lack of exercise, and obesity can accelerate the wear and tear of joints, leading to spondylosis. Occupational hazards involving lifting heavy weights or any history of trauma to the spine can also contribute to the condition.

Spondylosis is very common as age progresses. There are certain risk factors that may predispose you to develop spondylosis. These include:

• Age above 50
• Female gender
• History of trauma or injury to the spine or neck
• History of heavy weight lifting
• Poor posture
• Lack of exercise
• Smoking
• High intensity athletic activities

Following evaluations are performed by the doctor to confirm the diagnosis of spondylosis:

1. History and Physical Examination
   The doctor will require all details related to any past experience of the onset of your symptoms. A thorough physical examination may also be required to check for joint stiffness, muscle spasms, and muscle strength. The doctor may also conduct a neurological exam to evaluate the spine.
2. Imaging Studies
   • X-Ray Cervical Spine AP & Lateral - to study abnormalities, such as bone spurs, that indicate cervical spondylosis.
   • X-Ray Lumbar Spine AP & Lateral - to study bony changes in the lower back.
   • MRI Screening of Whole Spine - to evaluate details of soft tissues such as cartilage, nerve roots, muscles, spinal cord, and disks. This test can show spinal compression or herniated disks more clearly than X-rays. An MRI can help identify the source and location of pain.
   • CT Scan Spine - to rule out other possible causes of neurological symptoms like vertigo and headaches.
   • CT Myelography - to study whether the spinal cord is affected and, if so, to what extent. These tests provide more details on how and to what extent cervical spondylosis may be affecting your nerves.
   • Bone Densitometry Whole Body - to check for concomitant osteoporosis, a condition where the bones lack calcium and become brittle and weak.
3. Other Tests
   • Serum Calcium - to check for calcium deficiency, which plays an important role in bone and joint pains.
   • Vitamin D (25-OH) - to check for calcium deficiency, which is essential for calcium absorption in the body.
   • Nerve Compression Studies - NCV Upper Limb and NCV Lower Limb for cervical and lumbar spondylosis, respectively. These help evaluate nerve damage when symptoms such as tingling and radiating pain are present.
   • Electromyography - measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.

While spondylosis is an age-related condition that occurs as a result of degenerative changes and wear and tear of the spine, several measures can help prevent the occurrence of serious symptoms of spondylosis, including:

• Following a healthy diet rich in calcium, vitamin D, and other essential minerals.
• Ensuring adequate exposure to morning sunlight to maintain sufficient levels of vitamin D in the body.
• Engaging in regular exercise to maintain strength and mobility in the cervical and lumbar spine.
• Avoiding routine heavy weight lifting.
• Practicing proper ergonomics during weight lifting.
• Steering clear of sudden, jerky, and twisting movements of the spine.

The primary aim of the treatment of spondylosis is to provide pain relief and address other troublesome symptoms. The following medications are useful in the treatment of cervical and lumbar spondylosis.

1. Medical Management

NSAID Analgesics

This class of medicines helps relieve pain and inflammation. These medicines must always be consumed with meals as taking them on an empty stomach may irritate the gastric lining. Examples include:

• Ibuprofen
• Diclofenac
• Paracetamol

Opioid Analgesics

Also known as narcotic medications, these may be required when the pain is intense and is not relieved by the first line of medication. These potentially habit-forming tablets must be taken only when prescribed by the physician. These include:

• Tramadol
• Tapentadol

Bone and Joint Care Medications

This class of medicines helps in lubrication and reducing joint friction for easier joint movements. Examples include:

• Hyaluronic acid
• Glucosamine
• Chondroitin

Muscle Relaxants

These help relieve the painful spasms and stiffness associated with spondylosis. Examples include:

• Cyclobenzaprine
• Tizanidine
• Thiocolchicoside

Medications for Nerve Symptoms

These are useful in providing relief from radiating pain, tingling, and numbness in the upper and lower limbs. Examples are:

• Pregabalin
• Gabapentin
• Duloxetine

Corticosteroids

This may be prescribed for a short duration or even as an injection to address resistant pain symptoms. Medicines that belong to this class include prednisolone. A short course of oral prednisone might help ease the pain. If your pain is severe, steroid injections may be helpful.

Vitamins and Mineral Supplements

Nutrients like calcium and Vitamin D play a particularly important role. A walk in the morning sun would be one of the best ways to raise Vitamin D levels. Dietary intake of dairy products, fish, broccoli, kale, legumes, and tofu are useful in raising calcium levels.

Topical Analgesics and Rubefacients

Topical analgesics include NSAID preparations, rubefacients, cooling therapy preparations, and heat pads. Topical rubefacients presumably reduce pain by increasing local blood flow.

2. Surgical Management

Patients with advanced forms of spondylosis with very severe symptoms, who do not get relief with medications and physiotherapy, may require surgical treatment to remove the desiccated disc or other parts of the vertebrae. This will relieve compression from the spinal cord and help mobilize the intervertebral joint. If their neurological signs and symptoms such as weakness in their arms or legs worsen, they might need surgery. The surgery might involve:

• Removing a herniated disk or bone spurs
• Removing part of a vertebra
• Fusing a segment of the neck using bone graft and hardware

Spondylosis is an age-related degenerative condition that can cause pain and stiffness in the spine. Along with medications, the following home care tips can help manage symptoms and provide relief from the disease.

• Avoid lifting heavy weights.
• Maintain a wholesome, balanced diet rich in calcium and other minerals.
• Follow the exercise routine suggested by your doctor or physiotherapist.
• Apply topical analgesic preparations to relieve pain and stiffness.
• Use hot fomentation (moist heat application) or an ice pack to provide relief.
• Utilize cervical and lumbar supports, such as a cervical collar or lumbosacral belt, to support the spine. This can limit neck and back movement, allowing strained muscles to rest and recuperate. However, wearing a brace for extended periods can lead to muscle atrophy, so they should be used only for short durations.
• Change your mattress and sleeping pillow if they do not provide proper support. Use ones that stabilize the spine.

In some cases, spondylosis may cause severe and irreversible neurological complications, such as:

• Cervical myelopathy, which causes varying degrees of weakness and disability.
• Quadriplegia, a serious condition in which the body below the neck is paralyzed.
• Paraplegia, paralysis of both legs.

Surgery for spondylosis may also lead to complications, including:

• Nerve injury.
• Post-surgery kyphosis.
• Altered posture.

Along with medicines and topical analgesic preparations, various other treatment options are helpful in managing spondylosis. Here is a list of options to help you manage the symptoms:

• Exercise and Yoga: Regular exercises and yoga focused on strengthening the spinal musculature and improving mobility help manage the pain and stiffness caused by spondylosis.
• Physiotherapy: Physiotherapeutic modalities, such as Interferential Therapy (IFT) and Transcutaneous Electrical Nerve Stimulation (TENS), are very useful and offer pain relief even from nerve pain. These rehabilitation exercises focus on core strengthening of the spine, improving the overall strength of the spine.
• Acupressure and Acupuncture: Neck pain and back pain due to spondylosis may respond to acupuncture or acupressure therapy on the peripheral trigger points.
• Ayurveda: Various Ayurvedic preparations in the form of oils and liniments, such as camphor oil, menthol oil, and sesame oil, can be applied locally at the site of pain to provide relief from symptoms.
• Homeopathy: Homeopathic preparations, such as Rhus Toxicodendron, Calcarea Carbonica, Kalmia Latifolia, and Paris Quadrifolia, are known to improve pain and other troublesome symptoms in patients with spondylosis.
• External Orthoses Support: Cervical collars and lumbosacral belts offer much-needed support to the degenerative spine and are useful in alleviating pain caused by spondylosis. They may also help prevent or slow down further deterioration.

Spondylosis can be a considerable source of worry due to constant and prolonged pain. Patients with spondylosis are often unable to enjoy an active lifestyle because of the pain and stiffness. The quality of life is significantly impacted by the severity of the pain, and patients may become susceptible to anxiety and depression due to the nature of the disease.

If you suffer from spondylosis, it is essential to take adequate care of your spine to prevent further worsening. Consider the following recommendations:

• Follow all precautions as advised by your doctor.
• Take your medications on time.
• Avoid activities that require lifting weights, such as carrying large amounts of groceries or water buckets.
• Modify your household chores to avoid forward bending.
• Exercise regularly as advised by your physiotherapist.