CASE STUDY ON SPONDYLOSIS
Definition:
Spondylosis is a degenerative condition that may worsen as a person grows older. It can
affect any region of the spine.Spondylosis can affect the spine's intervertebral discs (eg,
degenerative disc disease) and facet joints
Epidemiology:
Spondylosis is a form of lower back pain and is an important clinical, social,
economic and public health problem affecting the worldwide population. It is a
disorder with many possible etiologies and many definitions. The incidence of
lumbar spondylosis is 27-37% of the asymptomatic lower back pain population. For
example, In the United States, more than 80% of individuals older than 40 years have
lumbar spondylosis, increasing from 3% of individuals aged 20-29 years.
Approximately 84% of men and 74% of women have vertebral osteophytes, most
frequently at T9-10 and L3 levels. Approximately 30% of men and 28% of women
aged 55-64 years have lumbar osteophytes. Approximately 20% of men and 22% of
women aged 45-64 years have lumbar osteophytes.
Etiology:
Spondylosis is an aging phenomenon. With age, the bones and ligaments in the spine
wear, leading to bone spurs (osteoarthritis). Also, the intervertebral discs degenerate and
weaken, which can lead to disc herniation and bulging discs. Spondylosis is common.
Symptoms are often first reported between the ages of 20 and 50. Over 80% of people
over the age of 40 have evidence of spondylosis on X-ray studies. The rate at which
spondylosis occurs is partly related to genetic predisposition as well as injury history.
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Signs &Symptoms:
Many people with spondylosis on X-ray do not have any symptoms. In fact, lumbar
spondylosis (spondylosis in the low back) is present in 27%-37% of people without
symptoms.
Back pain
Nerve compression
Bulging discs
Neck pain
Pinched nerve
Sciatica
Numbness and tingling
Weakness
Weight loss or fever.
Pathophysiology:
Intervertebral discs lose hydration and elasticity with age- leading to cracks and
fissures.
The surrounding ligaments also lose their elastic properties and develop traction
spurs
The disk subsequently collapses as a result of biomechanical incompetence,
causing the annulus to bulge on outwards.
As the disk space narrows, the annulus bulges, and the facets override.
This changes, in turn, increases motion at that spinal segment and further hastens
the damage to the disk.
Annulus fissures and herniation may occur.
Acute disk herniation may complicate chronic spondylotic changes.
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Diagnosis:
The diagnosis of spondylosis is made using radiology tests such as plain film X-rays,
MRI, or CT scans. X-rays can show bone spurs on vertebral bodies in the spine,
thickening of facet joints (the joints that connect the vertebrae to each other), and
narrowing of the intervertebral disc spaces. CT scans of the spine are able to visualize the
spine in greater detail and can diagnose narrowing of the spinal canal (spinal stenosis)
when present. MRI scans are expensive, but show the greatest detail in the spine, and are
used to visualize the intervertebral discs, including the degree of disc herniation, if
present. An MRI is also used to visualize the vertebrae, the facet joints, the nerves, and
the ligaments in the spine and can reliably diagnose a pinched nerve.
Treatment:
Non-pharmacological treatment:
Acupuncture: is a popular treatment used to help alleviate back and neck pain. Tiny
needles, about the size of a human hair, are inserted into specific points on the body.
Each needle may be twirled, electrically stimulated, or warmed to enhance the effect of
the treatment. It is believed that acupuncture works (in part) by prompting the body to
produce chemicals that help to reduce pain.
Bed Rest: Severe cases of spondylosis may require bed rest for no more than 1-3 days.
Long-term bed rest is avoided as it puts patient at risk for deep vein thrombosis (DVT,
blood clots in the legs).
Brace Use: Temporary bracing (1 week) may help relieve symptoms, but long-term use
is discouraged. Braces worn long-term weaken the spinal muscles and can increase pain
if not constantly worn. Physical therapy is more beneficial as it strengthens the muscles.
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Lifestyle Modification: Losing weight and maintaining a healthy weight, eating
nutritious foods, regular exercise, and not smoking are important 'healthy habits' to help
spine function at any age.
Physical therapy: combines passive treatments with therapeutic exercise. Passive
treatment modalities include heat/ice, ultrasound and electrical stimulation to alleviate
muscle spasm and pain. Therapeutic exercises teach the patient how to increase flexibility
and range of motion while building strength. Patients need not be fearful of physical
therapy. Even patients experiencing pain and great difficulty moving have found that
isometric exercises are beneficial.
Spinal Injections: There are many types of spinal injections including epidural steroid
injections and facet joint injections. These injections combine a local anesthetic and
steroid medication to reduce inflamed nerve tissues and thereby often help to reduce pain.
Surgery for Spondylosis
Surgery for patients with chronic low back pain is controversial, because while some
studies do show improvements in pain and disability, most studies do not show
improvement as compared to nonsurgical treatment such as physical therapy and pain
management. Also, many patients continue to have chronic back pain after the surgery.
Laminectomy is a procedure to remove the bony arches of the spinal canal
(lamina) subsequently increasing the size of the spinal canal and decreasing pressure
on the spinal cord.
Discectomy is a procedure to remove a portion of an intervertebral disc that is
putting pressure on a nerve root or the spinal canal.
Foraminotomy or foraminectomy is a procedure to expand the openings for the
nerve roots to exit the spinal canal. During a foraminectomy, generally more tissue is
removed than during a foraminotomy.
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Osteophyte removal is a procedure to remove bone spurs from an area where
they are causing pinched nerves.
Corpectomy is a procedure to remove a vertebral body and discs.
Pharmacological-treatment:
If over-the-counter pain relievers aren't enough, your doctor might prescribe:
Nonsteroidal anti-inflammatory drugs. While some types of NSAIDs are available over
the counter, you may need prescription-strength versions to relieve the pain and
inflammation associated with cervical spondylosis.
Corticosteroids. A short course of oral prednisone might help ease pain. If your pain is
severe, steroid injections may be helpful.
Muscle relaxants. Certain drugs, such as cyclobenzaprine, can help relieve muscle spasms
in the neck.
Anti-seizure medications. Some epilepsy medications, such as gabapentin (Neurontin,
Horizant) and pregabalin (Lyrica), can dull the pain of damaged nerves.
Antidepressants. Certain antidepressant medications have been found to help ease neck
pain from cervical spondylosis.
References:
www.webmd.com
www.wikipedia.com
www.emedicinehealth.com
Pharmacotherapy by ferri’s edition 2015
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