What is Spondylosis?
Spondylosis is a chronic, age-related degenerative condition of the spine characterized by degeneration of the intervertebral discs and facet joints, which can affect the cervical, thoracic, or lumbar regions. 1, 2
Definition and Pathophysiology
Spondylosis represents a noninflammatory degenerative disease that results from the natural aging process of the spinal column 1. The condition involves:
- Disc degeneration: Progressive breakdown of the intervertebral discs that normally cushion the vertebrae
- Facet joint arthritis: Wear and tear of the small joints connecting adjacent vertebrae
- Osteophyte formation: Development of bone spurs that can narrow the spinal canal or neural foramina
- Ligamentous changes: Thickening and calcification of spinal ligaments 2
The biomechanical basis is critical to understand: the disc and facets serve as connecting structures between vertebrae for force transmission and facilitate spinal mobility. As these structures degenerate, they can compromise the spinal canal diameter and compress neural elements 2.
Clinical Presentation
Spondylosis manifests through three distinct clinical syndromes 3, 4:
1. Axial Pain Syndrome
- Localized discomfort in the affected spinal region (neck or low back)
- Most common presentation
- Generally managed non-surgically 1
2. Radiculopathy
- Radiating pain into extremities due to nerve root compression
- Caused by osteophytes narrowing the neural foramina
- May include numbness, tingling, or weakness in specific nerve distributions 3, 4
3. Myelopathy (cervical spondylosis only)
- Spinal cord compression causing:
- Gait disturbances
- Hand clumsiness
- Bowel/bladder dysfunction
- Progressive neurological deterioration
- Results from mechanical pressure or ischemic changes to the spinal cord 2
Regional Variations
Lumbar spondylosis is the most prevalent form (58.7% in one large series), followed by cervical (28.6%), combined cervical-lumbar (11.8%), and thoracic (0.9%) 5. Cervical spondylosis is particularly significant as it can lead to myelopathy, a potentially disabling condition requiring careful monitoring 6, 2.
Risk Factors
The condition is multifactorial in etiology 1, with key risk factors including:
- Age: Risk increases significantly in the 40-59 year age group 5
- Female sex: Women show higher prevalence 5
- Smoking: Doubles the risk (AOR = 2.02) 5
- Alcohol consumption: Significantly associated with increased risk 5
Important Distinction
Spondylosis must be distinguished from spondylolisthesis (vertebral slippage) and ankylosing spondylitis (an inflammatory autoimmune condition). While the provided guidelines discuss spondylolisthesis 7 and ankylosing spondylitis 8, 9 extensively, these are separate entities from degenerative spondylosis. Ankylosing spondylitis is characterized by inflammatory back pain, sacroiliitis, and syndesmophyte formation leading to spinal fusion—a fundamentally different pathologic process 9.
Clinical Significance
Not all spondylosis is symptomatic 3. Many patients have radiographic evidence of degeneration without clinical symptoms. The challenge lies in determining when imaging findings correlate with the patient's symptoms, as degenerative changes are common incidental findings in asymptomatic individuals.
The majority of patients with spondylosis can be managed conservatively with NSAIDs, COX-2 inhibitors, physical therapy, and activity modification 1. Surgical intervention is reserved for patients with: