What happens to the spine
With age, the intervertebral discs lose water and become lower, which causes the load to be redistributed to the edges of the vertebrae and facet joints. In response to overload, the bone grows, forming osteophytes - this is how the body tries to stabilize the spinal segment. The cartilage of the facet joints becomes thinner, the joint capsule thickens, as with arthrosis of the knee joint. Osteophytes and thickened ligaments can narrow the intervertebral foramina and spinal canal, irritating the nerve roots. The process goes slowly, over years, and does not produce symptoms for a long time. In the thoracic region, which is strengthened by the ribs, changes are usually less noticeable.
- Cervical spondylosis - neck pain, headache, sometimes numbness in the arms
- Thoracic - less common and usually asymptomatic
- Lumbar – lower back pain, morning stiffness
- Spondyloarthrosis of the facet joints - pain during extension and rotation
- Complication - spinal canal stenosis
Causes and risk factors
The main factor is age, but the rate of change varies from person to person. It is increased by long-term loads on the spine: heavy lifting, vibration, long-term bending work. Excess weight constantly increases pressure on joints and discs. A weak muscle corset relieves stress on the spine worse, so a sedentary lifestyle is also harmful. Past injuries, poor posture, scoliosis, hereditary predisposition and smoking, which impair the nutrition of the intervertebral discs, are important. Often changes appear earlier in those who have been involved in weightlifting or wrestling for many years.
- Age
- Heavy physical labor and sports with axial load
- Overweight
- Inactivity, weakness of the back and abdominal muscles
- Scoliosis and posture disorders
- Spinal injuries
- Smoking
Symptoms
Many changes occur without symptoms. If there is pain, it is usually dull, aching, and worsens after long periods of standing, exercise, or at the end of the day. Spondyloarthrosis is characterized by short-term morning stiffness and pain when straightening the back and turning the body. Exacerbations alternate with periods of calm. When the spinal canal is narrowed in the lumbar region, pain and weakness appear in the legs when walking, which go away if you sit down or bend forward. Cervical spondylosis may be accompanied by a headache in the back of the head and numbness in the hands.
- Aching pain in the neck or lower back
- Stiffness in the morning and after rest
- Pain on extension and rotation
- Crunching and limited mobility
- Referred pain to the buttock or shoulder girdle
- Numbness and weakness in the limbs due to compression of the roots
Diagnostics
The doctor finds out the nature of the pain, conducts an examination, checks the mobility of the spine, reflexes, strength and sensitivity. X-rays can show osteophytes, decreased disc height, and joint changes. MRI more accurately shows the condition of the discs, ligaments, nerve roots and spinal canal; it is prescribed for radicular symptoms and suspected stenosis. CT is better at visualizing bone structures. If the pain is inflammatory in nature, ankylosing spondylitis is ruled out in young people. The severity of changes in the images does not always correspond to the severity of the pain, so the decision is made based on the totality of data.
- Neurological and orthopedic examination
- X-ray of the spine
- MRI of the lumbar or cervical spine
- MSCT of the spine for detailed bone assessment
- ENMG for numbness and weakness
- Blood tests to rule out inflammatory diseases
Treatment and prevention
Treatment is conservative and aimed at reducing pain and maintaining mobility. The basis is physical therapy: strengthening the muscles of the back and abdomen, flexibility exercises, swimming, walking. During an exacerbation, the doctor may prescribe non-steroidal anti-inflammatory drugs, muscle relaxants, physiotherapy, and massage. For persistent pain from the facet joints, blockades and radiofrequency denervation are used. Bed rest and prolonged wearing of a corset are not recommended, as they weaken the muscles. Surgery is considered for severe spinal stenosis and neurological deficits when conservative treatment does not help.
- Daily therapeutic exercises
- Losing weight if you are overweight
- Proper lifting technique
- Changing postures and breaks during sedentary work
- Swimming and Nordic walking
- Physiotherapy and massage as prescribed
- Quitting smoking