What are the causes and management options for spine osteophytes?

Spine Osteophytes: Causes and Management

Causes of Spine Osteophytes

Spine osteophytes are fibrocartilage-capped bony outgrowths that develop primarily as a feature of degenerative osteoarthritis and age-related spinal degeneration. 1

Primary Risk Factors and Pathophysiology

• Age is the dominant risk factor, along with increased body mass index, physical activity patterns, and genetic/environmental factors 1
• Transforming growth factor β plays a central role in the pathophysiologic cascade leading to osteophyte formation 1
• Vertebral osteophytes are classified into two morphologic types: traction spurs and claw spurs, both of which frequently coexist on the same vertebral rim and likely result from the same degenerative process rather than distinct pathologic mechanisms 2

Clinical Significance

• Osteophytes represent one of the principal radiographic diagnostic criteria for degenerative change in the lumbar spine 2
• While often asymptomatic, osteophytes can cause axial spine pain, limit range of motion, affect quality of life, and produce multiple symptoms depending on location 1
• Anterior cervical osteophytes rarely cause symptoms but can produce dysphagia when they compress the esophagus 3
• In rare cases, thoracic osteophytes can compress vital structures like the greater splanchnic nerve, causing thoracic and upper abdominal pain 4

Management Algorithm for Symptomatic Spine Osteophytes

Initial Conservative Management

Begin with medical management using NSAIDs and other non-steroidal anti-inflammatory agents as first-line therapy for pain control. 1

• Bisphosphonates are recommended for medical treatment of symptomatic osteophytes 1
• Fluoroscopic-guided injection of local anesthetic and corticosteroid near large intervertebral osteophytes can provide pain relief for axial low back pain unresponsive to traditional treatment modalities 5
• This injection approach specifically targets osteophytes as nociceptive pain generators when facet joints, intervertebral disks, sacroiliac joints, and myofascial structures have been ruled out 5

Indications for Surgical Intervention

Surgical treatment is reserved for patients with persistent symptoms despite conservative management, particularly when osteophytes cause mechanical compression of neural or vital structures. 3

Specific Surgical Scenarios:

• For anterior cervical osteophytes causing dysphagia: Left lateral cervicotomy with osteophytectomy is the procedure of choice 3

  • Osteophyte resection alone without fusion is recommended as the primary approach, as osteophytes do not regrow significantly in the long term in the majority of patients 3
  • Instrumented anterior fusion after osteophyte resection should be reserved for cases where there is concern about instability, though prophylactic fusion is not necessary in most cases 3

• For thoracic osteophytes compressing sympathetic structures: Transthoracic access to the anterolateral surface of the spine allows direct visualization and removal of compressive osteophytes 4

• For cervical degenerative myelopathy with posterior compression: Laminectomy is an acceptable surgical option for near-term functional improvement, though it carries increased risk of postoperative kyphosis compared to anterior techniques 6

  • The development of kyphosis does not necessarily diminish clinical outcome 6
  • Laminectomy is recommended specifically for patients in whom the risk of postoperative kyphosis is felt to be minimal 6

• For cervical radiculopathy from foraminal stenosis: Laminoforaminotomy achieves good or excellent results in 92-97% of patients with soft or hard disc herniation causing radiculopathy 6

Critical Pitfalls to Avoid

• Do not perform prophylactic instrumented fusion after anterior cervical osteophyte resection unless there is documented instability, as this adds unnecessary morbidity without proven benefit 3
• Do not delay surgical intervention when osteophytes cause progressive neurologic deficits, severe dysphagia with aspiration risk, or compression of vital structures 4, 3
• Do not assume traction spurs indicate spinal instability requiring fusion, as traction and claw spurs frequently coexist and result from the same degenerative process 2
• Recognize that vertebral osteophytes may be overlooked as a pain generator when traditional pain sources (facet joints, discs) are being evaluated 5

Long-term Outcomes

• Surgical resection of symptomatic anterior cervical osteophytes shows excellent long-term results with average functional swallowing scale improvement from 3.3 preoperatively to 1.2 at final follow-up (average 61.9 months) 3
• Only minimal reoccurrence of symptoms occurs in the long term after osteophyte resection without fusion 3
• Fluoroscopic-guided injections can provide sustained relief when osteophytes are confirmed as the pain source 5