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In-Depth Information
Degenerative changes of the spine are found to be present as early as age of 15,
but symptoms only develop in much older individuals [
4
]. In a community-based
study in the United States, facet joint osteoarthritis was found on CT scan in 36 %
of people younger than 45 years old, in 67 % who were 45
64 years old, and in
89 % who were older than 65 years [
5
]. A large epidemiologic study in Japan
reported the prevalence of radiographic lumbar spondylosis as 75.8 % in people
older than 60; however, only 28.8 % of these people had symptoms of low back
pain [
6
]. Aging and trauma are the main risk factors for developing spondylosis. No
associations have been established with other conditions, such as lifestyle, height,
obesity, physical activity, smoking and alcohol use.
-
2.1.2 Clinical Manifestations
Patients may present with a wide spectrum of symptoms. The majority of patients
with spondylosis do not have any symptoms, even with advanced changes on
radiographs.
In symptomatic patients, pain is the most common complaint. It may present as
acute episodes, or may be chronic. In some patients, pain is caused by osteoarthritis
of the facet joints, called facet joint syndrome. In lumbar facet joint syndrome, pain
travels down to the buttock and the back of the thighs, and typically improves with
bending forward and worsens with bending to the affected side. In cervical facet
joint syndrome, patients often complain of neck pain traveling along the spine, the
shoulder blades and the back of the head.
Limited motion of the neck or the back may occur, especially when trying to
extend the back or raise the head to look up. Osteophytes at the cervical facet joints
sometimes compress the arteries and decrease the blood supply to the brain, causing
dizziness.
Patients with spondylosis may have concurrent degenerative disk disease, or
may progress to develop spinal stenosis. These conditions often present with
neurologic symptoms, such weakness of the legs or the arms, numbness, or urinary
and/or bowel dysfunction. These conditions will be discussed in detail in the fol-
lowing sections.
2.1.3 Treatment
Conservative management is the mainstay treatment for patients who do not have
neurologic symptoms. Patient education on the natural history of spondylosis, self-
care options and coping techniques is the
first step. A long-term follow-up of
patients with neck pain found that in 79 % patients, the pain resolved after 15 years
without surgical intervention [
7
]. Immobilization of the cervical spine with a soft
collar is often used, however its effectiveness is not proven. In patients with back
pain, maintaining daily activity, instead of rest, is bene
cial. Physical therapy,
including mechanical traction and manipulation, are sometimes used. Exercise,
