Transcript osteochondrosis

osteochondrosis
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Osteoarthritis is a disease of the joints. Also
know as degenerative joint disease, it is the
most common form of arthritis, affecting more
than 20 million American adults. It should not be
confused with rheumatoid arthritis, which is not
the same as osteoarthritis. Osteoarthritis is
caused by a breakdown of cartilage, the
substance that provides a cushion between the
bones of the joints. Healthy cartilage allows
bones to glide over one another and acts as a
shock absorber during physical movement. In
osteoarthritis, the cartilage breaks down and
wears away. This causes the bones under the
cartilage to rub together, causing pain, swelling
and loss of motion of the joint.
What Causes Osteoarthritis?
Most cases of osteoarthritis have no known cause. Risk
factors include:
 Age – osteoarthritis affects more people over the age of
45
 Female – osteoarthritis is more common in women than
in men
 Certain hereditary conditions such as defective cartilage
and joint deformity
 Joint injuries caused by sports, work-related activity or
accidents
 Obesity
 Diseases that affect the structure and function of
cartilage, such as rheumatoid arthritis, hemochromatosis
(a metabolic disorder), Paget's disease and gout
Signs and Symptoms of Osteoarthritis
Osteoarthritis usually begins slowly. Early in the disease, joints may ache
after physical work or exercise. Often the pain of early osteoarthritis
fades and then returns over time, especially if the affected joint is
overused. Other symptoms may include:
 Swelling or tenderness in one or more joints, especially before or during
a change in the weather
 Loss of flexibility of a joint
 Stiffness after getting out of bed
 A crunching feeling or sound of bone rubbing on bone
 Bony lumps on the joints of the fingers or the base of the thumb
 Steady or intermittent pain in a joint (although not everyone with
osteoarthritis has pain)
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What Is Spondylosis? What Is Spondylosis?
Spondylosis (spinal osteoarthritis) is a degenerative disorder that may
cause loss of normal spinal structure and function. Although aging is the
primary cause, the location and rate of degeneration is individual. The
degenerative process of spondylosis may impact the cervical, thoracic,
and/or lumbar regions of the spine affecting the intervertebral discs and
facet joints.
What Is Spondylosis? What Is Spondylosis?
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Spondylosis (spinal osteoarthritis) is a
degenerative disorder that may cause loss of
normal spinal structure and function. Although
aging is the primary cause, the location and rate
of degeneration is individual. The degenerative
process of spondylosis may impact the cervical,
thoracic, and/or lumbar regions of the spine
affecting the intervertebral discs and facet joints.
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Spondylosis often
affects the
following spinal
elements:
Intervertebral Discs and Spondylosis
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As people age certain biochemical changes occur affecting tissue found
throughout the body. In the spine, the structure of the intervertebral discs
(anulus fibrosus, lamellae, nucleus pulposus) may be compromised. The
anulus fibrosus (e.g. tire-like) is composed of 60 or more concentric bands
of collagen fiber termed lamellae. The nucleus pulposus is a gel-like
substance inside the intervertebral disc encased by the anulus fibrosus.
Collagen fibers form the nucleus along with water, and proteoglycans.
The degenerative effects from aging may weaken the structure of the
anulus fibrosus causing the 'tire tread' to wear or tear. The water content
of the nucleus decreases with age affecting its ability to rebound following
compression (e.g. shock absorbing quality). The structural alterations from
degeneration may decrease disc height and increase the risk for disc
herniation.
Facet Joints (or Zygapophyseal Joints) and Spondylosis
The facet joints are also termed zygapophyseal joints. Each vertebral body
has four facet joints that work like hinges. These are the articulating
(moving) joints of the spine enabling extension, flexion, and rotation. Like
other joints, the bony articulating surfaces are coated with cartilage.
Cartilage is a special type of connective tissue that provides a selflubricating low-friction gliding surface. Facet joint degeneration causes
loss of cartilage and formation of osteophytes (e.g. bone spurs). These
changes may cause hypertrophy or osteoarthritis, also known as
degenerative joint disease.
Bones and Ligaments
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Osteophytes (e.g. bone spurs) may form adjacent to the end
plates, which may compromise blood supply to the vertebra.
Further, the end plates may stiffen due to sclerosis; a
thickening/hardening of the bone under the end plates.
Ligaments are bands of fibrous tissue connecting spinal structures
(e.g. vertebrae) and protect against the extremes of motion (e.g.
hyperextension). However, degenerative changes may cause
ligaments to lose some of their strength. The ligamentum flavum
(a primary spinal ligament) may thicken and/or buckle posteriorly
(behind) toward the dura mater (a spinal cord membrane).
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Cervical Spine and Spondylosis
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The complexity of the cervical anatomy and its wide range of
motion make this spinal segment susceptible to disorders
associated with degenerative change. Neck pain from spondylosis
is common. The pain may spread (radiate) into the shoulder or
down the arm. When a bone spur (osteophyte) causes nerve root
compression, extremity (e.g. arm) weakness may result. In rare
cases, bone spurs that form at the front of the cervical spine,
may cause difficult swallowing (dysphagia).
Thoracic Spine and Spondylosis
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Pain associated with degenerative disease is often triggered by
forward flexion and hyperextension. In the thoracic spine disc
pain may be caused by flexion - facet pain by hyperextension.
Lumbar Spine and Spondylosis
Spondylosis often affects the lumbar spine in people over the
age of 40. Pain and morning stiffness are common complaints.
Usually multiple levels are involved (e.g. more than one
vertebrae).
The lumbar spine carries most of the body's weight. Therefore,
when degenerative forces compromise its structural integrity,
symptoms including pain may accompany activity. Movement
stimulates pain fibers in the anulus fibrosus and facet joints.
Sitting for prolonged periods of time may cause pain and other
symptoms due to pressure on the lumbar vertebrae. Repetitive
movements such as lifting and bending (e.g. manual labor)
may increase pain.
Spondylosis Diagnosis
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Neurologic Evaluation
A neurologic evaluation assesses the patient's symptoms
including pain, numbness, paresthesias (e.g. tingling),
extremity sensation and motor function, muscle spasm,
weakness, and bowel/bladder changes. Particular attention
may be given to the extremities. Either a CT Scan or MRI
study may be required if there is evidence of neurologic
dysfunction.
X-Rays and Other Tests
Any patient experiencing back pain or stiffness in a joint or
joints for more than two weeks should see his or her
physician for an evaluation. The evaluation usually consists
of a discussion of symptoms and a detailed medical history,
a physical examination and—if osteoarthritis is suspected—a
series of x rays. Other tests (blood tests, MRI or CT scans)
may be performed to confirm the presence of spinal arthritis
or to rule out other conditions that can cause similar
symptoms, such as a tumor, infection, fracture, or other
types of arthritis.
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Diagnosing spinal osteoarthritis
Typically, the physician will use a combination of findings
from a patient’s medical history, physical exam and
medical tests to accurately diagnose whether a patient
has osteoarthritis. An accurate diagnosis is very
important for guiding the selection of treatment
options—and for actually helping relieve the pain and
discomfort associated with the patient’s condition.
Physical Examination
A thorough physical examination reveals a lot about the
health and general fitness of the patient. The exam
includes a review of the patient's medical and family
history. Often laboratory tests such as complete blood
count and urinalysis are ordered. The physical exam may
include:
Palpation (exam by touch) determines spinal
abnormalities, areas of tenderness, and muscle spasm.
Range of Motion measures the degree to which a patient
can perform movement of flexion, extension, lateral
bending, and spinal rotation.
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Medical history. The patient will be asked to describe his or her
symptoms, such as a description of the pain, stiffness and joint
function, when and how the symptoms started, and how the
symptoms have changed over time. The patient should also
discuss how the symptoms affect his or her everyday life and
work activities. The doctor also needs to know about the patient’s
other medical conditions, current medications, past experience
with other treatments, family history, and general lifestyle habits
(such as alcohol intake, smoking, etc.). When dealing with pain
problems, the doctor is likely to ask key questions related to
those things that reliably cause or aggravate the pain and those
that reliably bring relief or prevent the pain. Other questions may
relate to certain lifestyle topics, such as exercise, nutrition and
activities for diversion, sports, etc.
Physical examination. The doctor will conduct a physical exam
to assess the patient’s overall general health, musculoskeletal
status, nerve function, reflexes and direct evaluation of the
problematic joints in the back. The doctor will be looking at
muscle strength, flexibility, and the patient’s ability to carry out
daily living activities such as walking, bending, and reaching. The
patient may also be asked to perform some exercises to test
range of motion and determine whether pain worsens during any
particular type of movement.
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X-rays. The doctor will likely order an x-ray to see if there is joint
damage and how much joint damage has occurred. The x-ray can
show cartilage loss, bone damage, and the presence and location
of bone spurs. X-rays are also useful in helping to exclude other
causes of pain and to better inform possible considerations about
surgery. However, it is important to keep in mind that what shows
up in an x-ray may not correlate to the presence or absence of
osteoarthritis and associated pain. For example, most people over
age 60 have degenerative changes in their spine consistent with
osteoarthritis, but for perhaps 85% of them there is no pain or
stiffness. Conversely, an x-ray conducted during the early stages
of osteoarthritis may not yet show any visible damage to the
joints. For all these reasons, the clinical history and physical
examination are essential to arriving at an accurate clinical
diagnosis and plan of treatment.
Other tests may also be used to rule out conditions other than
osteoarthritis that may be causing the patient’s symptoms. For
example, blood tests are used to exclude diseases that can cause
secondary osteoarthritis or other types of arthritis that simulate
osteoarthritis. Joint aspiration, where fluid is drawn from the
joints through a needle for examination, can help rule out
conditions such as infections or gout.
Additional tests that may be needed to rule out other
causes of pain or to identify the presence of arthritis with
more sophistication than an x-ray can include:
A radioactive bone scan, used to rule out inflammation, a tumor, infection or a
small fracture. With a bone scan, the radioactive ‘tracer’ material is injected
intravenously and then is concentrated by the body where there is high
metabolism or bone turnover. If something suspicious is found on the bone
scan, it is usually followed by a CT or MRI scan to distinguish what the bone
lesion might represent, since the bone scan alone cannot distinguish among
tumors, infections or fractures.
A CT scan may be used to better show the adequacy of the spinal canal and
surrounding structures. A CT scan may also include myelography, where an
x-ray contrast dye is injected into the spinal column to show structures such
as a bulging disc or bone spur possibly pressing on the spinal cord or
nerves.
The MRI or magnetic resonance imaging scan, is a very sophisticated imaging
method that can show great anatomic details of the spinal cord, nerve roots,
discs, ligaments and surrounding tissues and spaces. Most MRI studies
require the patient to lie flat in a tube for about 40 minutes, although open
frame and even standing MRI scanners exist and seem particularly
appropriate for patients having claustrophobia (fear of tight spaces). MRI
scans can be adjusted to show different tissues including their water
content, important in determining disc degeneration, infections or tumors.
The goal of all diagnostic studies is to discover patterns or confirmations
between the various tests that point to a clear diagnosis among various
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The key is to diagnose the condition causing the patient’s pain and
disability and to guide appropriate treatment, including
psychological, physical, medical and/or surgical. Diagnosis is a
detective hunt for causes and effects with the goal of improved
treatment.
Radiographs (x-rays) may indicate loss of vertebral disc height and
the presence of osteophytes, but is not as useful as a CT Scan or
MRI.
The CT Scan may be used to reveal the bony changes associated
with spondylosis. An MRI is a sensitive imaging tool capable of
revealing disc, ligament, and nerve abnormalities.
Discography seeks to reproduce the patient's symptoms to identify
the anatomical source of pain. Facet blocks work in a similar
manner. Both are considered controversial.
The physician compares the patient's symptoms to the findings to
formulate a diagnosis and treatment plan. Further, the results from
the examination provide a baseline from which the physician can
monitor and measure the patient's progress.
Treatment
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Conservative treatment is successful 75% of the time. Some patients
may think that because their condition is labeled degenerative they are
doomed to end up in a wheel chair some day. This is seldom the case.
Many patients find their pain and other symptoms can be effectively
treated without surgery.
During the acute phase, anti-inflammatory agents, analgesics, and
muscle relaxants may be prescribed for a short period of time. The
affected area may be immobilized and/or braced. Soft cervical collars
may be used to restrict movement and alleviate pain. Lumbosacral
orthotics may decrease the lumbar load by stabilizing the lumbar spine.
In physical therapy, heat, electrical stimulation, and other modalities
may be incorporated into the treatment plan to control muscle spasm
and pain.
Physical Therapy (PT) teaches the patient how to strengthen their
paravertebral and abdominal muscles to lend support to the spine.
Isometric exercises can be helpful when movement is painful or difficult.
Exercise in general helps to build strength, flexibility, and increase range
of motion.
Lifestyle modification may be necessary. This may include an
occupational change (e.g. from manual labor), losing weight, and
quitting smoking.
Surgery
Seldom is surgery used to treat spondylosis or spinal osteoarthritis.
Conservative forms of treatment are tried first.
If there is neurologic deficit, certain surgical procedures may be
considered. However, before surgery is recommended, the patient's
age, lifestyle, occupation, and number of vertebral levels involved
are carefully evaluated.
A spinal physician is able to determine if surgery is the best treatment
for the patient.
Recovery
Always follow the instructions provided by the physician and/or physical
therapist. This includes:
 Take medication as directed. Report side effects to your physician
immediately.
 Follow the home exercise program provided by the physical therapist.
 Avoid heavy lifting and activities that aggravate pain or other symptoms.
 Try to keep your weight close to ideal.
 Stop smoking.
Any doubts concerning vocational and recreational restrictions should be
discussed with your physician and/or physical therapist. They will be able
to suggest safe alternatives to help reduce the risk of further back
problems.