Spondylosis is a general or -umbrella" term for the degenerative disease process affecting the spine, in particular, the intervertebral discs and the vertebral facet joints. Your doctor may use this term or degenerative disc disease to describe the typical age-related anatomic changes in the spine due to wear and tear. It is believed that these degenerative changes begin at the intervertebral disc; for example, a tear in the outer layer of the disc, known as the annulus. These changes then have deleterious effects on the facet joints and the ligamentous, neural, and bony relations of the spine. Narrowing of the space between vertebrae (from disc degeneration) is an important cause of many of these interdependent degenerative changes to the lumbar spine [Figure 1 ]. Progressive degenerative changes in the facet joints can lead to marked instability and both conditions can entrap nerves and eventually lead to chronic nerve damage. Advanced spondylosis can include thickening and ossification of spinal ligaments that further contribute to nerve compression.
Figure 1: Degenerative disc diseases: A) Vertebral osteophytes B) facet arthrosis C) disc degeneration.
Symptoms of lumbar spondylosis follow those associated with each of the various aspects of the disorder: disc herniation, sciatica, spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis all of which are discussed in further detail below. Pain associated with disc degeneration may be felt locally in the back or at a distance away. This called referred pain, as the pain is not felt at its site of origin. Lower back arthritis may be felt as pain in the buttock, hips, groin, and thighs. As with spinal stenosis or disc herniation in the lumbar region, it is important to be aware of any bowel or bladder incontinence, or numbness in the perianal area. These signs and symptoms could represent an important massive nerve compression needing surgical intervention (see cauda equina syndrome below).
Figure 2: Spondylosis: Note severly
decreased height of several disc
spaces (white arrow) and anterior
osteophytes (bone spur,open arrow).
Also,sclerosis (3 arrowheads)
of posterior facet joints, consistent
with osteroarthritis (x-ray)
X-ray studies demonstrate much of the characteristic appearance of spondylosis narrowing of the intervebral disc space and the neural foramina (bony canals by which the spinal nerves exit the vertebral column). Also visible is the presence of osteoarthritis and the formation of osteophytes (small bone spurs) on areas of the vertebrae adjacent to the discs and in the area of the facet joints [Figure 2 ]. Soft tissue injuries such as herniated disc and nerve root impingement are best seen with advanced imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and myelography.
Management of the various degenerative components of spondylosis depends upon the type of presentation, the age of the patient, and the degree of severity of the disease. Nonoperative treatment with or without rehabilitation may be very effective for some aspects and surgical intervention for others (see below for treatment information on separate conditions).
The prognosis of spondylosis is related to the age, severity, components of the disorder. While elimination of the disease is not likely, early and appropriate treatment can minimize or manage many symptoms effectively.