INTRODUCTION Spondylosis (spinal osteoarthritis) is a degenerative disorder.It is the general wear and tear that occurs in the joints and bones of the spine as people get older.More than 85% of people over age 60 are affected.Spondylosis may affect the cervical (neck), thoracic (mid-back), or lumbar (low back) regions of the spine.
It may cause loss of normal spinal shape and function. Although aging is the primary cause, the location and rate of change is different from person to person.
AREAS AFFECTED Cervical (neck) The complex anatomy and large movements in the neck make this area of the body susceptible to degenerative change. Neck pain from spondylosis is common. The pain may spread into the shoulder or down the arm.Thoracic (mid-back) The thoracic spine is less commonly affected due to its reduced movement. If there is spondylosis in this region the shape of the mid back can round to the appearance of a hunchback, this is called a kyphosis.
Lumbar (low back)Spondylosis often affects the lumbar spine in people over the age of 40. Pain and morning stiffness are common complaints. Usually many levels are involved. The lumbar spine carries most of the bodys weight. Therefore, when degenerative changes affect its structure you may get pain with activity such as walking and standing, lifting objects or after long periods of rest.
CAUSES dehydrate, become Aging : when we get older, the discs thinner and become harder. They then provide less support to the vertebrae resting on the discs. Repetitive strain injury (RSI) caused due to lifestyle without ergonomic care, e.g., while working in front of computers, driving, traveling, intense work in farm, etc. Risk factors: Genetics – if family has a history of neck pain Smoking: clearly linked to increased neck pain Occupation: jobs with lots of neck motion and overhead work Mental health issues :depression/anxiety Injuries/trauma: car wreck or on-the-job injury
PATHOPHYSIOLOGY Cervical spondylosis is the degeneration of the intervertebral disk. When we get older the disk, fragment, lose water content and collapse. This starts in the nucleus pulposes (the inner part of the IVD), the water content will decrease and will buckling inward, the annulus fibrosis (the outer part of the IVD) will become thinner and bulge outward. When the IVD become thinner it will increase the mechanical stress at the cartilaginous end plates at the vertebral body lip. The cartilage that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone.
To make up for the lost cartilage, our body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth called spurs may narrow the space for the nerves to pass through (stenosis). Some cases, encroach on nervous tissue. In addition, hypertrophy of the uncinate process occurs, often encroaching on the ventrolateral portion of the intervertebral foramina. It can "pinch" or compress those nerves.
Dynamic factors relate to the fact that normal flexion and extension of the cord may aggravate spinal cord damage initiated by static compression of the cord. During flexion, the spinal cord lengthens, resulting in it being stretched over ventral osteophytic bars. During extension, the ligamentum flavum may buckle into the cord, pinching the cord between the ligaments and the anterior osteophytes.
SIGN AND SYMPTOMS Pain from cervical spondylosis can be mild to severe. Neck pain and stiffness (may be worse with activity). Numbness and weakness in arms, hands, and fingers Trouble walking, loss of balance, or weakness in hands or legs Muscle spasms in neck and shoulders Headaches Grinding and popping sound/feeling in neck with movement
DIAGNOSIS X-ray : These pictures are traditionally ordered as a first step in imaging the spine. X-rays will show aging changes, like loss of disk height or bone spurs. Magnetic resonance imaging (MRI) : This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord. Computed tomography (CT) scans: This specialized x-ray study allows careful evaluation of the bone and spinal canal.
NON-SURGICAL TREATMENT Soft Collars (neck immobilization) These collars limit neck motion and allow the muscles of the neck to rest. Soft collars should only be worn for short periods of time because long-term wear can decrease the strength of neck muscles.
Environmental changes-proper lifting techniques-wear soft collar to restrict unwanted movements-avoiding prolonged sitting or standing, and selectingthe proper chair-Workplace modifications and ergonomics serve toreduce strenuous neck positions during work andleisure.
Cervical mechanical traction Studies regarding its efficacy are conflicting, with intermittent traction probably being more effective than static traction. Initially, a weight of 4.5 kg is recommended, eventually increasing to 5.5 kg as tolerated. Indicated for cervical radiculopathy. It is contraindicated in patients who have myelopathy, a positive Lhermitte sign, or rheumatoid arthritis with atlantoaxial subluxation.
PHYSIOTHERAPY MANAGEMENT Heat therapy: By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste by products created by muscle spasms, and it also helps healing. Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.
Electrical stimulation: TENS unit can be issued to a patient for home use. E-stim stimulates your muscles through variable intensities of electrical current. It helps reduce muscle spasms, your natural pain killers. It may also drive out inflammation, bring in healing properties, relax, and re- educate the muscles involved. Deep Tissue Massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).
Hip bridging SLR Towel exercise Weight pulley
MEDICATIONS The goal of pharmacotherapy is to reduce pain and inflammation. Acetaminophen: Mild pain is often relieved with acetaminophen. Non-steroidal anti-inflammatory drugs (NSAIDs): Often prescribed with acetaminophen, drugs like ibuprofen and and naproxen are considered first-line medicines for neck pain. They address both pain and swelling, and may be prescribed for a number of weeks. Muscle relaxants: Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.
SURGICAL METHODS Surgery is reserved for patients who have severe pain that has not been relieved by other treatment. Some patients with severe pain will unfortunately not be candidates for surgery. This is due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.Laminectomy