Definition of Mild Spondylosis
Mild spondylosis refers to early degenerative changes in the spine characterized by disc degeneration, minor osteophyte formation, and facet joint changes that typically do not cause significant spinal canal narrowing or neurological compromise. 1, 2
Anatomical and Pathological Features
Spondylosis represents a generalized degenerative disease process affecting the spine that includes:
- Intervertebral disc degeneration with loss of disc height and hydration 2, 3
- Osteophyte formation (bone spurs) at the vertebral body margins 2, 3
- Facet joint hypertrophy and degenerative changes 2
- Ligamentous thickening, including potential ossification 1
- Minor segmental instability in some cases 2
The key distinction of "mild" spondylosis is that these changes are present but do not produce significant spinal canal stenosis or neural compression that would lead to myelopathy or severe radiculopathy. 4, 1
Clinical Context and Natural History
Mild spondylosis is strongly associated with the aging process, with prevalence and severity increasing with age—approximately 53.9% of patients demonstrate disc degenerative changes in imaging studies. 1 The critical point is that senescent and pathologic processes are morphologically indistinguishable, meaning these changes are often part of normal aging. 2
Asymptomatic degenerative changes on imaging are extremely common and may not require treatment. 5 The association between radiographic findings and clinical symptoms remains unclear, which is why imaging must always be interpreted in combination with clinical findings. 1
Functional Severity Classification
In the cervical spine specifically, mild spondylotic myelopathy (when neurological involvement occurs) is defined by:
- Modified Japanese Orthopaedic Association (mJOA) scale scores >12 4, 6, 5
- Minimal to no gait disturbance (gait disturbance indicates established myelopathy, not mild disease) 5
- Absence of progressive neurological deficits 4
Clinical Implications
Most cases of mild spondylosis with axial neck or back pain respond to conservative treatment measures, including activity modification, immobilization, and anti-inflammatory medications. 6, 7 For cervical involvement, 75-90% of patients with mild radiculopathy achieve symptomatic relief with conservative therapy. 1
The critical pitfall to avoid: Do not rely solely on imaging findings for treatment decisions, as spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of pain. 6 The diagnosis of "mild" spondylosis must integrate both imaging findings and clinical presentation—imaging changes without symptoms do not constitute clinically significant disease. 1, 5