2. 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.
3. PATHOPHYSIOLOGY
• 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 the 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.
4. TYPES
Cervical (neck) Spondylosis
• 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) Spondylosis
• 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
• 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 body's
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.
5. CAUSES
• Aging : When we get older, the discs dehydrate, become 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
7. SURGICAL MANAGEMENT
• Laminectomy: is a procedure to remove the bony arches of the
spinal canal decreasing pressure on the spinal cord.
• Discectomy: is a procedure to remove a portion of an
intervertebral disc that is putting pressure on a nerve root or the
spinal canal.
• Foraminectomy: is a procedure to expand the openings for the
nerve roots to exit the spinal canal.
• Fusion: fusion of the vertebrae is sometimes combined with one
or more of these procedures in order to stabilize the spine.
8. PHARMACOLOGY MANAGEMENT
• Acetaminophen: Tylenol is an example of an acetaminophen, a
type of medication that has proven to be a good pain reliever.
Acetaminophen works by essentially blocking the brain's
perception of pain, and it's good for pain flare-ups that may come
with spondylosis.
• Muscle relaxants: Because of the anatomical changes to the
spine from spondylosis, muscles may have to work harder to
support the spine. Sometimes, the muscles can have spasms as
they become overworked. So muscle relaxant, will help to stop the
spasms. Valium is an example of a muscle relaxant.
9. PHYSIOTHERAPY MANAGEMENT
Heat Therapy
• Improves blood circulation, decreases nerve and muscle inflammation and it
relieves muscle spasm
Cold Therapy
• Decreases inflammation, relieves muscle spasm and it reduces nerve irritation
by reducing nerve edema.
Soft Collars (neck immobilization)
• Immobilization limits the motion of the neck, thereby reducing the nerve
irritation. It allow the muscles of the neck to rest. Soft collars should only be
worn for short periods of time because long-term can decrease the strength of
neck muscles.
10. PHYSIOTHERAPY MANAGEMENT
Electrical stimulation
• TENS - can be issued to a patient for home use. Stimulates the muscles
through variable intensities of electrical current. It helps reduce muscle
spasms and pain. It may also drive out inflammation, bring in healing
properties, relax, and re-educate the muscles involved.
• SWD - Relieves muscle spasm and causes muscle relaxation, reduces
inflammation and it improves blood circulation
Traction
• This form of treatment may be useful for spondylosis because it
promotes immobilization of the cervical region and widens the foraminal
openings.
11. PHYSIOTHERAPY MANAGEMENT
Manual therapy
• Such as mobilization and manipulation, may provide further relief
for patients with cervical spondylosis. Mobilization is
characterized by the application of gentle pressure within or at
the limits of normal motion, with the goal of increasing the ROM.
Manipulation is characterized by a high-velocity thrust, which is
often delivered at or near the limit of the ROM. The intention is
to increase articular mobility or to realign the spine.
13. EVIDENCE
• Mobilisation, manipulation, and exercise seem to be equally
effective. A study comparing combined exercise and manipulation
with either modality alone found the combination to be more
effective at three months, but no difference was seen compared
with exercise alone at one and two years. However, another
pragmatic study found no advantage at six weeks or six months of
adding manual therapy (63% of patients had mobilisation
physiotherapy) or heat (shortwave diathermy) to exercise and
advice.
• G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H
Spine (Phila Pa 1976). 2001 Apr 1
14. EVIDENCE
• Randomised controlled trials identified by systematic reviews
provide moderate evidence that various exercise regimens—using
proprioceptive, strengthening, endurance, or coordination
exercises—are more effective than usual care (analgesics, non-
steroidal anti-inflammatory drugs, or muscle relaxants) or stress
management, although not all studies have found exercise
beneficial. One randomised controlled trial found exercise plus
infrared heat no more effective than transcutaneous electrical
nerve stimulation plus heat at relieving pain at six weeks and six
months, although both were better than heat alone.
• Sarig-Bahat H Man Ther. 2003 Feb 8
