Many patients are confused by the similarity of the terms spondylosis, spondylitis and spondylolisthesis. When researching spine conditions, it is essential to research the correct condition for you. In this article, we explain the difference between “spondylosis” and “spondylitis” and “spondylolisthesis” so patients can spend time researching the correct medical condition to take proactive measures to find a treatment solution.
Read about Neck exercises for Cervical Spondylosis
SPONDYLOSIS (spinal arthritis)
Spondylosis is degenerative spinal deformity caused by age-related ‘wear and tear’ to bones and tissues spinal column. More than 85 percent of people over age 60 are affected with spondylosis. The degenerative process (wear and tear) of spondylosis may affect the neck (cervical), mid-back (thoracic), or low back (lumbar) regions of the spine.
Causes of spondylosis
- Aging: When we get older, the discs between the vertebrae become thinner and harder. They then provide less support to the vertebrae resting on the discs.
- RSI (Repetitive strain injury): Caused due to a lifestyle without ergonomic care, example; while working in front of computers, driving, traveling, intense work on the farm, etc.
- Occupation: Jobs with lots of neck motion and overhead work
- Genetics: If family has a history of neck pain
- Smoking: Clearly linked to increased neck pain
Pathophysiology of spondylosis
- Cervical spondylosis is the degeneration of the IVD (intervertebral disk). When we get older the disk, fragment, lose water content and collapse.
- It starts in the nucleus pulposes (the inner part of the IVD), the water content will decrease and will buckle inward, and the annulus fibrosis will become thinner and bulge outwards.
- When the intervertebral discs become thinner, it will increase the mechanical stress at the cartilaginous endplates at the vertebral body.
- The cartilage (elastic tissue) that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone.
- To make up for the lost elastic tissue (cartilage), our body may respond by growing new bone in the facet joints to help support the vertebrae.
- Over time, this extra bone growth called spurs may narrow the space for the nerves to pass through (stenosis). Some cases encroach on nervous tissue.
- Also, hypertrophy of the uncinate process occurs, often encroaching on the ventrolateral portion of the intervertebral foramina. It can “pinch” or compress those nerves.
Symptoms of spondylosis
Symptoms of spondylosis include numbness, tingling sensations, and weakness in the affected areas.
- In neck spondylosis, this can affect the arms, hands, or fingers cause mild to severe neck pain.
- In lumbar spondylosis, there will be the presence of back pain in the lower back, and sometimes legs may be affected.
Other symptoms can include:
- Muscle spasms in neck and shoulders, and back
- Loss of balance and difficulty in walking
- A sensation of popping or grinding that can happen during movement of the spine
- Headaches
Diagnosis of spondylosis
- X-rays: X-rays shows aging changes, like loss of disk height or bone spurs.
- CT (computed tomography) scans: This specialized x-ray study allows careful evaluation of the bone and spinal canal.
- MRI (magnetic resonance imaging): This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.
Treatment options for spondylosis
Medical management
The goal of medical management is to reduce pain and inflammation.
Muscle relaxants: Medications such as carisoprodol or cyclobenzaprine can also be used in the case of painful muscle spasms.
NSAIDs (Non-steroidal anti-inflammatory drugs): Often prescribed with acetaminophen, drugs like ibuprofen and naproxen are considered first-line medicines for neck pain and back pain.
Physical therapy management
Heat therapy: By using heat, the physiotherapist improves the blood supply to the affected area, because a greater amount of blood flow brings more Oxygen and nutrients to affected area. Blood is also needed to remove waste byproducts created by muscle spasms, which helps in healing.
Cold therapy, also called Cryotherapy, slows the blood circulation and contributes to reducing inflammation, muscle spasms, and pain.
Electrical stimulation: TENS or E-stim stimulates your muscles through variable intensities of electrical current. It helps to treat muscle spasms, act as a natural painkiller. It may also drive out inflammation, bring in healing properties, relax, and re-educate the muscles involved.
Deep Tissue manipulation: This technique used to relieve muscle spasms and chronic muscle tension. Your physical therapist uses direct pressure and friction to release the tension in your muscles ligaments, and tendons.
Your physiotherapist suggests cervical collars or lumbar belts limit neck or back motion and allow the muscles to rest.
Environmental changes, proper lifting techniques, wear a soft collar to restrict unwanted movements-avoiding prolonged sitting or standing and selecting the proper chair-Workplace modifications and ergonomics serve to reduce strenuous neck positions during work.
Surgery is indicated for the patients who have severe pain that has not been relieved by other treatment.
SPONDYLITIS
Spondylitis is an inflammation of the soft tissues of the (cervical ) neck or lumbar (back) vertebrae. It leads to pain in the neck, shoulder, hands, back, and legs; with numbness and tingling sensation. Prolonged use of, computers, poor posture, extended periods of sitting and weakness of neck and back a muscle leads to spondylitis in young people.
‘Spondylo’ is a Greek word meaning vertebra. Spondylitis means changes in the vertebral joint characterized by increased degeneration of the intervertebral disc with subsequent changes in bones and soft tissues.
Most often in above the 40 years age groups, the intervertebral discs become progressively dehydrated and become more compressible and less elastic. Mineral deposition begins to occur in the intervertebral disc, resulting in subsequent changes. Although most individuals over 40 years of age show significant radiological evidence of previous changes, only a small percentage develops symptoms of it. Another important point is that sometimes degenerative changes in the spine may be visible on the radiograph as early as the 30’s, but does not require any treatment if the patient is not symptomatic.
These changes result in compression of the spinal nerves leading to radiculopathy (pain, numbness, weakness due to compression of the spinal nerves).
Compression of the spinal cord resulting in spondylotic myelopathy (SM ) (Commonly caused by spinal stenosis resulting in loss of sensation and movement). Neural compression, as well as spinal cord compression, will lead to radiculomyelopathy.
Treatment options for spondylitis
Treatment options for spondylitis depend on several factors, including the age and overall health of the patient, severity of the symptoms, and the extent of vertebral slippage. Treatment most often is conservative, involving rest, medication, and physiotherapy. More severe spondylolisthesis may require Decompressive laminectomy or spinal fusion surgery.
Medical management: the person should take a break from sports and other activities until the pain subsides. An over-the-counter NSAID (non-steroidal anti-inflammatory drugs) are recommended to help reduce pain and inflammation.
A lumbar brace or back support might be used to help stabilize the lower back and reduce pain. A program of exercise and physiotherapy will help increase pain-free movement, and improve flexibility and muscle strength.
Physiotherapy: Stabilization exercises are the mainstay of treatment. These exercises strengthen the abdominal and back muscles, minimizing bony movement of the spine. 8 to 12 weeks of aggressive daily treatment with stabilization exercises are needed to achieve clinical improvement.
SPONDYLOLISTHESIS
It is the condition of the spine, occurs when one vertebra slips forward onto the vertebrae below it. It produces both a progressive deformity of the lower back and also a narrowing of the vertebral canal. It is often associated with pain.
Spondylolisthesis is a painful spinal condition, but it is treatable in most cases. Both conservative (medication, physiotherapy) and surgical methods may be used. Proper exercises can help you avoid this condition.
Types of Spondylolisthesis
Spondylolisthesis is officially categorized into 5 major types:
Degenerative Spondylolisthesis
It occurs through arthritis occurs when the joints, lose their ability to keep the alignment of the spine in its normal position. It can cause the vertebra to slip forward.
Traumatic Spondylolisthesis
It is caused by injury or trauma to the vertebrae. A fracture of the lamina or facets and pedicle can cause the vertebra to slip forward.
Pathologic Spondylolisthesis
It is caused by a disease, such as a tumor or other bone disease which leads to structural weakness to the bones. This weakness causes the vertebra to slip forward.
Dysplastic Spondylolisthesis
It is caused by a congenital defect (present at birth) in the formation of part of the vertebra called the facet. This defect leads to the vertebra to slip forward.
Isthmic Spondylolisthesis
It is caused by a defect in a part of the vertebra called the pars interarticularis. This defect leads to the vertebra to slip forward.
Causes of Spondylolisthesis
In children, spondylolisthesis usually occurs between the 5th bone in the lumbar vertebra and the 1st bone in the sacrum (pelvis) region. It is often due to injury (acute trauma) or a congenital disability in that area of the spine.
In adults, it occurs commonly due to degenerative arthritis (abnormal wear on the cartilage and bones) of the spine.
Spondylolisthesis also caused by bone disease and fractures. Certain sports activities, such as weightlifting, gymnastics, and football, put excess stress on the bones in the lower back. They also require that the athlete constantly overstretches the spinal column. It can lead to a stress fracture on of the spinal vertebra. Stress fractures can cause a spinal bone to become weak and shift out of place.
Symptoms of Spondylolisthesis
The symptoms of spondylolisthesis vary. During acute stage may not have any symptoms. However, people with chronic cases may be unable to perform daily activities. Some of the most common symptoms are:
- persistent lower back pain
- stiffness in your lower back and legs
- muscle tightness or weakness in the lower limbs (sciatica)
- lower back tenderness
- thigh pain
- tight hamstring and buttock muscle
- These symptoms are usually aggravated by some of the activities such as standing, walking, while rest will provide temporary relief.
Treatment options for Spondylolisthesis
Treatment options for spondylolisthesis depend on several factors, including the age and overall health of the patient, severity of the symptoms, and the extent of vertebral slippage. Treatment most often is conservative, involving rest, medication, and physiotherapy. More severe spondylolisthesis may require Decompressive laminectomy or spinal fusion surgery.
Medical management: the person should take a break from sports and other activities until the pain subsides. An over-the-counter NSAID (non-steroidal anti-inflammatory drugs) are recommended to help reduce pain and inflammation.
A lumbar brace or back support might be used to help stabilize the lower back and reduce pain. A program of exercise and physiotherapy will help increase pain-free movement, and improve flexibility and muscle strength.
Physiotherapy: Stabilization exercises are the mainstay of treatment. These exercises strengthen the abdominal and back muscles, minimizing movement of the spine. 8 to 12 weeks of aggressive daily treatment with stabilization exercises are needed to achieve clinical improvement.
Surgery: Surgery may require if the pain is not relieved by conservative treatment and begins to interfere with daily activities or vertebra continues to slip. The main aim of surgery for spondylolisthesis is to ease the pain, correct the vertebral slippage slipped, and to improve the patient’s activities of daily living.
Usually, 2 surgical procedures are done to treat spondylolisthesis. The first surgery is a Decompressive laminectomy, which involves removing the part of the bone that is pressing on the nerves. The second surgery is spinal fusion performed to provide stability.
For more information, do get in touch with us through email at help@healthclues.net or message us on WhatsApp at +91-9640378378, or submit your question below.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.
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