What is the diagnosis and treatment for spondylosis (degenerative spinal disease)?

From the Guidelines

Spondylosis should be managed with conservative approaches as the first line of treatment, focusing on pain relief and physical therapy to improve quality of life and reduce morbidity. Spondylosis is a general term for age-related degeneration of the spine that can occur in the neck (cervical), mid-back (thoracic), or lower back (lumbar) regions. It involves wear and tear of the spinal discs and joints, leading to bone spurs, disc herniation, and narrowing of the spinal canal. Common symptoms include pain, stiffness, and sometimes numbness or weakness if nerves are compressed. According to the guidelines from the American College of Physicians and the American Pain Society 1, treatment typically begins with conservative approaches including over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours) or NSAIDs such as ibuprofen (400-800mg three times daily with food).

Key Considerations

• Physical therapy focusing on strengthening core and back muscles is crucial, along with maintaining proper posture and ergonomics.
• Heat or cold therapy can provide temporary relief.
• For more severe cases, prescription medications like muscle relaxants (cyclobenzaprine 5-10mg) or targeted injections may be recommended.
• Surgery is generally reserved for cases with significant nerve compression or when conservative treatments fail.
• Spondylosis is a natural part of aging, but its progression can be slowed by maintaining a healthy weight, regular exercise, good posture, and avoiding smoking.

Diagnostic Approaches

• The straight-leg-raise test can be used to assess for nerve root tension and sciatica.
• Imaging studies may show degenerative changes, but these correlate poorly with symptoms.
• A thorough history and physical examination are essential for diagnosing spondylosis and ruling out other underlying conditions.

Treatment Goals

• Improve quality of life by reducing pain and improving function.
• Slow the progression of spondylosis through lifestyle modifications.
• Avoid unnecessary interventions and focus on evidence-based treatments.

From the Research

Definition and Diagnosis of Spondylosis

• Spondylosis represents a weakness or stress fracture in one of the bony bridges that connect the upper with the lower facet joints of the vertebra 2
• It is the most common cause of low back pain in young athletes, with one-half of all pediatric and adolescent back pain in athletic patients related to various disturbances in the posterior elements including spondylolysis 2
• Plain radiography with posteroanterior (P-A), lateral, and oblique views have proved very useful in the initial diagnostics of low back pain, but imaging studies such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are more sensitive in the establishment of the diagnosis 2

Relationship between Spondylosis and Spondylolisthesis

• Spondylolisthesis is defined as the forward displacement of one vertebrae upon another, usually at the L5-S1 level, but also occurring at L4-5 3
• For spondylolisthesis to occur, there must be an anatomical change in the structures which normally resist the anterior displacement of one vertebrae upon the other, such as a defect in the pars interarticularis 3
• Isthmic spondylolisthesis is a type of spondylolisthesis that occurs due to a defect in the pars interarticularis, often associated with spondylolysis 3

Treatment Options for Spondylosis and Spondylolisthesis

• Conservative management strategies for spondylolisthesis include instruction in exercise and body mechanics, the use of back supports, and job modifications 3
• Surgical intervention is indicated for symptomatic cases of spondylolisthesis when conservative methods fail, or for patients with radiculopathy, neurogenic claudication, progressive neurological deficits, high-grade slips, or bladder and bowel symptoms 4
• For spondylolysis, treatment options include conservative management with physical therapy, bracing, and activity modification, with surgical treatment reserved for cases that fail conservative management 2

Clinical Presentation and Prognosis

• The most common clinical presentation of spondylolysis is low back pain, which is aggravated by activity and is frequently accompanied by minimal or no physical findings 2
• Symptoms of spondylolisthesis can vary depending on the degree of disarticulation, with radiculopathy occurring in advanced grades of spondylolisthesis 4
• The majority of patients with spondylolysis and spondylolisthesis will improve with conservative treatments, with surgical options warranted after 6 months of failed conservative treatments for patients with severe symptoms or neurological deficits 4