2.
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.
INTRODUCTION
3.
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.
4.
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.
AREAS AFFECTED
5.
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 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.
6.
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
CAUSES
7.
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.
PATHOPHYSIOLOGY
8.
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.
10.
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.
11.
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
SIGN AND SYMPTOMS
12.
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.
DIAGNOSIS
14.
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.
NON-SURGICAL
TREATMENT
15.
Environmental changes
-proper lifting techniques
-wear soft collar to restrict unwanted movements
-avoiding prolonged sitting or standing, and selecting
the proper chair
-Workplace modifications and ergonomics serve to
reduce strenuous neck positions during work and
leisure.
16.
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.
17.
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.
PHYSIOTHERAPY
MANAGEMENT
18.
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).
20.
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.
MEDICATIONS
21.
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
SURGICAL METHODS
