When osteoarthritis affects the spine, it is known as spondylosis. Spondylosis is a degenerative disorder that can cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration varies per person. Spondylosis can affect the cervical, thoracic and/or lumbar regions of the spine, with involvement of the intervertebral discs and facet joints. This can lead to disc degeneration, bone spurs, pinched nerves, and an enlargement or overgrowth of bone that narrows the central and nerve root canals, causing impaired function and pain.
When spondylosis affects the lumbar spine, several vertebrae usually are involved. Because the lumbar spine carries most of the body’s weight, activity or periods of inactivity can both trigger symptoms. Specific movements, sitting for prolonged periods of time, and lifting and bending all may increase pain. When spondylosis worsens, a patient may develop spinal stenosis — a narrowing of spaces in the spine that results in pressure on the spinal cord and/or nerve roots. The narrowing can affect a small or large area of the spine. Pressure on the upper part of the spinal cord may produce pain or numbness in the shoulders and arms. Pressure on the lower part of the spinal cord or on nerve roots branching out from that area may cause pain or numbness in the legs. Degenerative spondylolisthesis (slippage of one vertebra over another) is caused by osteoarthritis of the facet joints. Most commonly, it involves the L4 slipping over the L5 vertebra. It most frequently affects people age 50 and older. Symptoms may include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles.
- Pain and stiffness in the neck or low back
- Pain that radiates into the shoulder or down the arm
- Weakness or numbness in one or both arms
- Pain or morning stiffness that lasts for about 30 minutes due to inactivity
- Pain that worsens throughout the day due to activity
- Limitation of motion
- Anti-inflammatory medications to reduce swelling and pain, and analgesics to relieve pain. Most pain can be treated with nonprescription medications, but if pain is severe or persistent, your doctor may recommend prescription medications.
- Epidural injections of cortisone may be prescribed to help reduce swelling. This treatment is not recommended repeatedly and usually provides only temporary pain relief.
- Physical therapy and/or prescribed exercises may help stabilize your spine, build your endurance and increase your flexibility. Therapy may help you resume your normal lifestyle and activities. Yoga may be effective for some people in helping to manage symptoms.
- Maintaining a proper weight is crucial to effective management of osteoarthritis. Being overweight is a risk factor for osteoarthritis.
Surgery may be recommended if conservative treatment options, such as physical therapy and medications, do not reduce or end the pain altogether, and if the pain greatly impairs the person’s daily functions.
Spondylolisthesis is defined as the forward displacement of one vertebrae over another usually the fifth lumbar on the sacrum or the fourth lumbar vertebrae on the fifth. Spondylolisthesis is less common among young children, occurring primarily in adolescents and adults.
Symptoms resulting from spondylolisthesis vary. Some people have no pain or other symptoms. In extreme cases, the deformity may be a visible increase in the curvature of the spine in the lumbar region, which can affect movement. Often there is mild to moderate low back pain, particularly after exercising. If the forward slippage compresses a nerve, leg pain often develops.
What causes spondylolisthesis?
A fracture, break or defect of the pars interarticularis, also known as spondylolysis often leads to spondylolisthesis. This defect may be present at birth, occur as the vertebrae develops, or as the result of degeneration or injury. This defect in the pars occurs in 5-8% of the population due to unknown causes.
Treatment depends on the amount of slippage, severity of symptoms and age at the time of diagnosis. Non-surgical treatments include activity modification, brace or cast application, physical therapy, non-steroidal anti-inflammatory medication and periodic monitoring of symptoms or slippage. Surgery may be indicated if there is no response to the non-surgical treatments, there is progressive or severe slippage, development of muscle weakness or changes in bowel or bladder function. Spinal fusion of the affected area is the most common surgery performed.