The spine is a complex structure with many moving parts. There are a number of spinal conditions that can develop, many of which are caused by spinal degeneration. Some causes of spinal degeneration are natural age-related deterioration, while others can involve the presence of another degenerative spinal condition and lifestyle factors.
The term spondylosis is just that: a term. Spondylosis describes symptoms of a degenerative spinal condition but is not a condition itself. A literal translation of the term references back problems that involve pain and/or spinal degeneration but not the underlying cause of pain and related symptoms.
Let’s start our discussion of spondylosis, including different forms and treatment, after first defining the term itself.
While the name ‘spinal column’ can make it sound as if the spine is one long individual structure, it is actually made up of many different complex and moving parts.
A healthy spine helps us stand upright, practice good posture, engage in flexible movement, and absorb and distribute mechanical stress.
The spine also helps protect vital organs, and as the brain and spine work together to form the central nervous system (CNS), it facilitates brain-body communication and is involved in virtually all bodily systems.
As such an integral and complex structure, the spine can develop a number of issues and conditions that impact its overall health and function.
Spondylosis is a term, not a clinical diagnosis, that references pain and spinal degeneration, but the source of the pain and degeneration could be a number of spinal conditions/issues, and the term doesn’t refer to where along the spine the pain/degeneration is coming from.
Spondylosis often involves a defect in the pars interarticularis, a piece of bone that attaches the facet joints at the back of the spine, giving it structure or intervertebral disc deterioration.
There are three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back), and while spondylosis can occur in any section of the spine, it most commonly affects the cervical and lumbar sections.
If a person has cervical spondylosis, they are experiencing spinal degeneration in the cervical section of the spine. Thoracic spondylosis refers to degeneration in the middle/upper back, while lumbar spondylosis refers to degenerative changes isolated to the lower back.
Before we move on to the possible causes of spondylosis symptoms, let’s talk about spondylosis and the diagnostic process.
As there is such a wide range of spinal conditions a person can develop, and as mentioned, spondylosis is more of an umbrella term that references general spinal degeneration, let’s talk about determining the underlying cause of spondylosis.
While every case is different, if a patient presents with general age-related changes to the vertebrae (bones of the spine) and the intervertebral discs, a finding of spondylosis can indicate the need for further testing to determine if the underlying cause is another spinal issue or condition.
A comprehensive physical examination includes taking the patient’s medical history to determine if there is a predisposition towards a specific spinal condition or medical issue. As well as observing their general posture and how they walk, plus X-ray imaging, when necessary, I can find the information needed to determine if spondylosis is related to natural age-related changes or if it has an underlying cause.
If I find that the spondylosis symptoms have a causative source, I want to specify the condition further so it can be properly assessed, diagnosed, classified, and treated.
Ultimately, I want to make a clinical diagnosis as specific because a full diagnosis effectively describes what’s causing the degeneration and pain and guides the design of an effective and customized treatment plan.
So as spondylosis is a descriptive term that references spinal issues related to deterioration commonly causing pain, let’s break down that term to address its two main components: spinal degeneration and pain.
Spinal Degeneration and Types of Spondylosis
The spine is made up of bones (vertebrae) that are rectangular in shape and stacked on top of one another in a straight and natural alignment.
The vertebrae are separated by intervertebral discs that provide the spine with structure, enable flexible movement, and act as the spine’s shock absorbers.
The discs have two main structures: a soft inner gel-like nucleus and a durable and tough outer annulus.
When it comes to understanding spinal degeneration, it’s important to discuss the intervertebral discs as they are generally the first parts of the spine to experience degenerative changes, and a deteriorating disc also affects adjacent vertebrae.
While both the inner nucleus and outer annulus are made up of water, collagen, and proteoglycans (PGs), the nucleus has a higher concentration.
PGs are protein chains that help attract and retain water. When we are born, the discs are made up of 80-percent water, but as we age, natural degenerative changes, plus the cumulative effect of certain lifestyle choices, can further decrease a disc’s hydration level.
As the discs don’t have their own vascular supply, meaning no direct path in and out for absorbing blood (nutrients and oxygen) and eliminating waste, once a disc has started to degenerate, it’s a lengthy process to work towards a reversal of some of those effects.
Through movement, the discs replenish themselves as it keeps them hydrated and increases circulation around the discs, making important nutrients needed for cellular repair available for the discs to absorb through a process of osmosis; this is where the lifestyle choices mentioned earlier come into play.
Those who carry excess weight, lead a sedentary lifestyle, have chronic poor posture, or repeatedly lift heavy objects incorrectly can impact spinal health and function by speeding up spinal degeneration and risking injury.
Disc desiccation can occur if a disc becomes dehydrated due to degeneration, lack of movement, and/or the lifestyle mentioned above.
As mentioned, a degree of spinal degeneration is to be expected as we age, and particularly for women going through menopause, the changes to hormones and bone density make them vulnerable to a number of degenerative spinal conditions such as osteoporosis and osteoarthritis.
Osteoarthritis can cause spondylosis because of joint and cartilage problems. Also referred to as degenerative arthritis, it’s the most common type of arthritis and is related to degenerative disc disease, annular tearing, facet joint arthritis, spondylolisthesis, and/or spinal stenosis. These conditions/diseases are all related to spinal degeneration in different parts, capable of causing spondylosis related to arthritic changes.
While many patients present with both osteoarthritis and osteoporosis, they are two different diseases. While not commonly painful, osteoporosis is a bone problem and involves the loss of bone mass (osteopenia), which weakens the spine and increases its risk of injury, specifically fractures, and can cause spondylosis related to bone-mass changes.
When conditions like osteoporosis or osteoarthritis are present, these involve joint, cartilage, and bone conditions that can lead to spondylosis because of their impact on spinal health and function.
Disc degeneration can be caused by degenerative disc disease which can also lead to bulging and/or herniated discs: also related to spondylosis.
Now that we have addressed some aspects of spinal degeneration and how different spinal conditions can cause different types of spondylosis, let’s talk about how these degenerative changes cause pain, as this is what brings most adult patients in for a diagnosis and treatment.
As the other component of spondylosis, pain is the main indicator that the spine is facing degenerative changes, especially in adults.
One aspect of spinal conditions and degeneration that I find many people are unaware of is how differently adolescent and adult patients experience related pain.
In most cases, spinal conditions are less likely to be painful in patients who are still growing, and this is due to the lengthening motion of a growing spine counteracting the compression: the main source of pain in a number of spinal conditions and diseases.
As mentioned, as the discs start to degenerate, they can become dehydrated and lose height, meaning the positioning of adjacent vertebrae are disrupted due to the disc’s change in shape.
Once this happens, the vertebrae are no longer aligned with the rest of the spine, and this can cause a number of issues related to misalignment and exposing the spine to uneven forces.
In addition, as mentioned, the discs act as cushions between adjacent vertebrae so they don’t rub up against each other during movement, but once a disc loses height, the cushioning effect is reduced, and this can cause increased degeneration of the vertebrae themselves.
The discs also act as the spine’s shock absorbers, so if one or more is not functioning optimally, this means that mechanical stress incurred during movement isn’t being evenly absorbed and distributed, and this further exposes the spine to uneven forces and wear.
It’s not just the spine that’s charged with maintaining its natural curvatures and alignment; the back and core muscles also play a role in providing essential support and stabilization for the spine.
If the spine is deteriorating and is exposed to uneven forces, it becomes more of a struggle for the muscles surrounding the spine to adequately support and stabilize it, which can lead to sore, tight, and strained muscles.
While every condition is different and pain levels can vary widely, pain related to nerve compression is known to be one of the worst types of back pain.
The spinal cord is part of the central nervous system (CNS) that starts at the bottom of the brain stem and extends the length of the entire back.
The spinal cord runs through the spinal column, facilitating brain-body communication, thanks to the nerves transmitting signals and messages within.
When a spine is experiencing degeneration, often related pain is caused by nerve compression.
When a nerve is exposed to uneven pressure, it can result in pain not only at the site, but also radicular pain that’s commonly felt in the legs and feet, particularly when spinal degeneration is occurring in the lumbar spine (lower back).
Nerve pain can be felt at the site of compression or span the entire length of a nerve’s pathway, ranging from mild and intermittent to chronic and debilitating.
Nerve pain can also cause sensations of tingling and/or numbness.
So now that we have defined spondylosis and broken down the term into its main components of spinal degeneration and related pain, let’s move on to compare spondylosis and spondylolysis.
When a number of spinal conditions are left untreated, they can progress in severity, which is what can happen if spondylosis isn’t addressed and treated proactively: it can become spondylolysis.
Spondylolysis involves a defect in the pars interarticularis, a bony arch in the back of the spine located between the facet joints.
When the pars interarticularis separates, it compromises the structure of the spine as the facet joints connect the bones of the spine; when this happens, it exposes the affected vertebrae and discs to uneven pressure which makes it difficult for the spine to maintain its natural and healthy alignment.
In addition, if left untreated, spondylolysis can become spondylolisthesis, when one vertebra slips forward over another and can intrude on the space within the spinal canal, decreasing nerve space within.
While spondylosis is most common in adults as they age, adolescents who participate in certain sports that involve repeated hyperextension of the lumbar spine are also at risk for early spinal deterioration; these types of sports include diving, gymnastics, wrestling, and some track and field sports.
While younger people can develop spondylosis, as mentioned, due to the fact that they have not yet reached skeletal maturity and their growing spines can counteract compression, pain can be absent, making it hard to diagnose the condition until it’s progressed and become spondylolysis.
In some cases, a spinal injury is to blame, and other times, as mentioned, its intervertebral disc damage and general spinal degeneration that causes spinal instability.
In addition, family history and congenital defects can also lead to the development of spondylolysis, as can certain occupations that involve repeatedly lifting heavy objects.
Some patients will experience noticeable spondylolysis symptoms such as lower back pain, leg pain, a swayback appearance, or a protruding stomach, while others don’t experience noticeable symptoms and discover the condition by accident when being X-rayed for an unrelated problem.
So if spondylosis is present, this means there is an issue with the spine’s structure due to spinal degeneration that commonly involves the intervertebral discs and/or facet joints, and if left untreated, it can lead to further structural damage in the pars articularis and become spondylolysis.
Let’s now move on to discussing spondylosis treatment options.
While every case is different and there are no treatment guarantees, in most cases, spondylosis can be treated conservatively with a variety of noninvasive treatment modalities.
The first step to effectively treating spondylosis is to assess and diagnose the underlying cause of the spinal degeneration.
Common causes of spondylosis involve disc and facet joint deterioration that can be due to natural age-related deterioration, the presence of spinal conditions such as osteoarthritis and/or osteoporosis, a spinal injury, certain lifestyle choices, and/or genetic factors.
As spondylosis is a general term, and not a specific condition itself, once the underlying cause of the spinal degeneration is determined, it drives the design of an effective treatment plan moving forward.
Here at the Scoliosis Reduction Center, I offer patients a conservative chiropractic-centered treatment approach that integrates different forms of treatment for the best potential results.
If lifestyle choices exacerbate natural age-related spinal deterioration, I provide guidance on how to make positive changes that are sustainable and can impact overall spinal health and function: healthy diet and activity levels, losing weight, practicing good posture, and being educated on the ergonomics of heavy lifting.
Through precise and condition-specific chiropractic care, I can help patients work towards reversing some disc degeneration by adjusting vertebrae back into a healthier alignment with the rest of the spine so an intervertebral disc can reclaim its central position between adjacent vertebrae.
Through physical therapy and custom-prescribed exercises, we also work towards increasing core strength so the muscles surrounding the spine are stronger and better able to support and stabilize it; this also increases circulation around the discs so they can absorb important nutrients needed for cellular repair.
As is always my approach with treating any spinal condition, there is a big difference between treating symptoms of a condition, or the condition itself.
When it comes to spondylosis, as this is an umbrella term that references degenerative changes to the spine and related symptoms like pain, any effective form of treatment has to first determine the underlying cause of the changes happening in the spine, and the underlying cause has to be addressed proactively to prevent increasing condition severity.
As such a complex structure, the spine can develop a number of conditions and issues that impact its overall biomechanics and health.
As different parts and systems within the body can show signs of age-related deterioration, the spine is no exception.
Generally, the discs of the spine feel the first effects of degeneration with conditions like degenerative disc disease (DDD), and osteoarthritis/osteoporosis can also increase the rate of spinal degeneration by weakening the cartilage, joints, and bones of the spine.
Spondylosis is a broad term that describes general spinal degeneration and common related symptoms like pain (more common in adults).
So as spondylosis is more of a general descriptive term, rather than a clinical diagnosis, the underlying cause of the spinal deterioration has to be assessed, diagnosed, and treated proactively.
If spondylosis is left untreated, the underlying cause of spinal deterioration remains unaddressed and is likely to get worse with age.
As spondylosis often involves degeneration of the facet joints and/or the intervertebral discs, spondylosis left untreated can turn into spondylolysis, which involves a vertebral defect caused by the separation of the pars interarticularis.
Once the spine is exposed to uneven forces such as those caused by a spinal disc becoming dehydrated, losing height, and changing the position of adjacent vertebrae, it can no longer function optimally and needs to be proactively addressed.
When it comes to treatment options for spondylosis, these include a full and comprehensive exam that further specifies the cause of spondylosis symptoms, as it’s the underlying cause of the spinal degeneration that becomes the driving force behind the design of customized and effective treatment plans.
Here at the Scoliosis Reduction Center, I treat spondylosis by first determining its underlying cause and crafting a customized treatment plan around it.