What is Spondylosis?
Spondylosis is a degenerative condition of the spine characterized by disc degeneration, osteophyte formation, and facet joint arthritis that can affect any region of the spine, leading to pain and potential neurological symptoms.
Definition and Pathophysiology
Spondylosis is a chronic, non-inflammatory degenerative disease that primarily involves:
- Degeneration of intervertebral discs
- Formation of osteophytes (bone spurs) on vertebral bodies
- Hypertrophy of facet joints
- Thickening of ligaments
- Potential narrowing of the spinal canal and neural foramina 1
The condition represents the natural aging process of the spine, making senescent and pathologic processes morphologically indistinguishable 1. It can affect any part of the spine but is most common in the cervical and lumbar regions.
Types of Spondylosis
Cervical Spondylosis
- Typically produces intermittent neck pain in middle-aged and elderly patients
- May cause radiculopathy (nerve root compression) or myelopathy (spinal cord compression) in advanced cases
- Neurological symptoms occur more frequently in patients with congenital spinal stenosis 2
Lumbar Spondylosis
- Characterized by degeneration of lumbar discs and/or facet joints
- Presents with low back pain and potentially radiating leg pain
- May progress to lumbar spinal stenosis with neurogenic claudication
- Can be associated with spondylolisthesis (forward slippage of one vertebra over another) 3, 4
Diagnostic Evaluation
Imaging Studies
Radiography is the first-line imaging modality:
- Shows degenerative changes, osteophytes, disc space narrowing
- Can identify spondylolisthesis and gross alignment issues 5
MRI is recommended when:
- Neurological symptoms are present
- Radiographs are negative but clinical suspicion remains high
- Should include fluid-sensitive sequences (STIR or T2-weighted fat-saturated) 5
CT may be useful:
- For detailed evaluation of bony structures
- When MRI is contraindicated
- To assess for spondylolysis (pars defects) 5
Clinical Presentation
Common symptoms include:
- Localized pain in the affected spinal region
- Stiffness, particularly in the morning
- Reduced range of motion
- Radicular symptoms (pain, numbness, tingling in extremities) when nerve roots are compressed
- Myelopathic symptoms (gait disturbance, hand clumsiness, bladder/bowel dysfunction) when spinal cord is compressed in cervical spondylosis 2
Treatment Options
Conservative Management
- NSAIDs for pain control
- Physical therapy and exercise programs
- Activity modification
- Neck or back immobilization for acute symptoms
- Epidural steroid injections for radicular symptoms 2, 3
Surgical Intervention
Indicated for:
- Persistent pain unresponsive to conservative treatment
- Progressive neurological deficits
- Significant functional impairment
For Cervical Spondylosis:
- Anterior or posterior surgical approaches may be used
- Long-term improvement in 70-80% of patients with radiculopathy
- More modest results (70% initial good outcomes) for myelopathy 2
For Lumbar Spondylosis:
- Decompression for stenosis without instability
- Fusion procedures for spondylosis with instability or spondylolisthesis
- Lumbar fusion is recommended for patients with low back pain due to 1-2 level degenerative disc disease that is refractory to conservative treatment 5
Prognosis
- Most patients with spondylosis can be managed successfully with conservative treatment
- Surgical outcomes are generally favorable for radiculopathy
- Myelopathy has a more guarded prognosis, with functional outcomes declining in long-term follow-up 2
- Surgical intervention for lumbar spondylosis with spondylolisthesis has demonstrated superior outcomes compared to non-surgical management 5
Common Pitfalls
- Overreliance on imaging findings without clinical correlation (degenerative changes are common in asymptomatic individuals)
- Delayed diagnosis of myelopathy, which can lead to irreversible neurological damage
- Inadequate trial of conservative management before considering surgery
- Failure to recognize that adjacent segments may degenerate after fusion procedures