The body is vulnerable to degenerative changes as we age, and the spine is no exception. While spondylosis refers to general spinal degeneration commonly caused by arthritis of the spine and/or degenerative disc disease, spondylolysis refers to a specific injury commonly affecting the pars articularis and caused by overuse.
As such a complex structure with many moving parts, the spine can develop a number of conditions. Spondylosis refers to degenerative changes within the spine, often related to arthritis; spondylolysis refers to a defect in the pars interarticularis of the vertebrae, often related to an injury.
Before we move on to the specific details and differences between spondylosis and spondylolysis, let’s talk about basic spinal anatomy for a more comprehensive understanding of how degenerative changes can affect the spine’s structure and function.
When discussing conditions that affect the spine, it’s important to understand its basic structure.
The spine has three main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
The spine is made up of bones called vertebrae that are rectangular in shape and stacked on top of one another in a straight and natural alignment; facet joints connect the bones of the spine.
The pars interarticularis (pars for short) is part of each individual vertebra as part of the facet joint: an important structure in the development of spondylolysis, which we’ll return to later.
The spine has natural curvature types that are characteristic of each spinal section; the spine is curved because it makes it stronger, more flexible, and better able to absorb/distribute mechanical stress.
Part of the spine’s optimal function and health is about maintaining those natural and healthy spinal curves because when they are lost, the spine’s biomechanics are disrupted, which can affect how it functions.
The vertebrae are separated by intervertebral discs, and particularly when it comes to spinal degeneration, such as spondylosis, the discs are important because they are generally the first spinal structures to experience degenerative changes.
The discs of the spine have two main components: a soft gel-like interior known as the nucleus pulposus and a tough, durable outer layer known as the annulus fibrosus.
The discs provide the spine with structure, giving adjacent vertebrae something to attach to, enabling flexible movement, and acting as the spine’s shock absorbers.
The spine is also vulnerable to degenerative changes, particularly as we age, so let’s move on to defining one such condition: spondylosis.
Spondylosis is more of a descriptive term than a clinical diagnosis that references general spinal degeneration but doesn’t specify the cause or location of the degenerative changes.
With osteoarthritis, what’s happening is there is a loss of space between the vertebrae, and this is caused by the wearing down of protective cartilage found on the ends of the vertebrae.
Protective cartilage helps prevent adjacent vertebrae from rubbing up against one another during movement, creating friction, and causing excessive wear and tear.
As is the case with most forms of spinal degeneration, it tends to worsen with age, and for women over the age of 40, changes to bone density and hormones related to menopause can make them particularly vulnerable to the development of osteoarthritis.
People with osteoarthritis might start to develop a more pitched-forward posture. They can also experience symptoms of lower back pain, leg pain, and/or feelings of tingling and numbness related to the extent of nerve involvement.
When there is a loss of space within the spine, this leaves less room for important spinal nerves, potentially exposing them to uneven pressure and compression, which can lead to localized and/or radicular nerve pain commonly felt in the extremities.
Degenerative disc disease is also connected to spondylosis because, as mentioned, the intervertebral discs perform many important roles in maintaining the spine’s structure, flexibility, natural curvatures, and acting as the spine’s shock absorbers.
When a disc starts to degenerate, it tends to change shape and lose height, often caused by disc desiccation, which affects adjacent vertebrae.
So, spondylosis is an umbrella term for spinal degeneration commonly caused by arthritis of the spine or the degeneration of the intervertebral discs.
So now that we have defined spondylosis, plus some of its primary causes, let’s move on to defining spondylolysis.
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Unlike the more general spondylosis term, spondylolysis references a specific defect within the vertebrae, or more accurately, where they connect.
While spondylolysis can develop anywhere along the spine, it most commonly affects the lumbar spine as the lower back plays a dominant role in supporting the weight of the entire upper body. In addition, the lower back is also instrumental in everyday movements such as bends, twists, and also works hard to coordinate hip, pelvic, leg, and feet muscles.
Now, if the cause of spondylosis is undetermined and/or is left untreated, this can lead to further spinal damage and injury, which can lead to spondylolysis.
Spondylolysis occurs when there is a vertebral stress fracture defect in the pars, and most commonly affects the lower back.
Most often, this is related to repeated stress and/or trauma experienced by the lumbar spine. Strenuous activities, sports, or harmful repetitive movements that involve excessive twisting and rotating of the spine can lead to a crack and/or fracture.
Activities like gymnastics, dancing, and football also involve excessive back bending, which can expose the spine to uneven pressure and cause excessive wear and tear.
Some individuals with spondylolysis will be unaware of their injury, while others can experience back pain while bending forward or with general activities.
Age is a big determining factor when it comes to how painful a spinal condition is; a growing spine is less vulnerable to compression because its lengthening motion can counteract compression, known to be a primary source of pain in a number of spinal conditions.
However, if an injury like a stress fracture is left untreated and progresses, related symptoms tend to increase in severity.
So the connection between spondylosis and spondylolysis is that people who are experiencing spinal degeneration, regardless of causation, are more prone to spinal injuries like fractures.
The main difference between the two is that spondylosis is a general term referencing general spinal degeneration, most commonly caused by arthritis of the spine and/or degenerative disc disease, while spondylolysis references a specific injury (crack and/or fracture) caused by a structural defect in the pars of affected vertebrae.
In addition, while spondylosis is more related to age-related spinal deterioration, spondylolysis commonly affects adolescents participating in certain sports and activities that expose the lower back to repeated stress.
A stress fracture caused by overuse can weaken a vertebra so much that it's unable to maintain its alignment with the rest of the spine and can slip out of place: spondylolisthesis.
Now that we have defined both terms, spondylosis, and spondylolysis, and touched on their connection and differences, let’s move on to talk about treatment options.
Fortunately, there are many different forms of treatment for preserving the spine’s overall health, function and for addressing spinal degeneration and stress fractures.
Here at the Scoliosis Reduction Center, my patients benefit from a conservative chiropractic-centered approach that prioritizes spinal health and function throughout treatment and beyond.
When it comes to treatment for spondylosis, my goal, first and foremost, is to determine the underlying cause of the spinal degeneration.
Once I know what’s causing the deterioration of the spine, whether it’s natural age-related spinal degeneration, osteoarthritis, and/or degenerative disc disease, it’s the underlying cause that guides the crafting of an effective and customized treatment plan.
While there are no treatment guarantees and every case is different, my conservative and chiropractic-centered treatment approach for spondylosis commonly includes integrating different forms of treatment such as physical therapy and chiropractic care.
I use physical therapy to work towards increasing core strength; this is important because it’s not just the spine that’s charged with maintaining its structure and healthy curves, but also important core and spinal muscles.
Increasing core muscle strength also helps take pressure off the discs as the muscles can help provide the spine with crucial support and stabilization.
In addition, therapeutic exercises can also help increase spinal flexibility and range of motion, which is a positive thing for the spine and its discs. Through movement, the discs stay hydrated and can replenish themselves.
Through condition-specific chiropractic care, I can help patients make improvements to their nervous system by addressing a subluxation (misalignment) of a vertebra.
If a vertebra is misaligned, it can stress the nervous system by exposing nearby nerves to uneven pressure and compression.
Through a combination of chiropractic techniques such as ice/heat therapy, ultrasound, lifestyle modification, ultrasound, and spinal adjustments, I can work towards pain management, preventing further damage, and realigning the spine.
Adjusting the most-affected vertebrae back into alignment with the rest of the spine improves spinal biomechanics, function, and disc health and helps strengthen the spine and its surroundings, decreasing the chances of sustaining a vertebral crack or fracture.
When it comes to treatment for spondylolysis, again, it’s important to determine the underlying cause of the injury, and the general goal of treatment is pain management and allowing the fracture to heal.
Spondylolysis involves a crack or fracture between vertebrae, commonly involving the pars, caused by an overuse injury. Taking a break from the activity and resting the spine can be an important aspect of treatment.
Physical therapy is another important treatment modality as it involves educating patients on the proper use of therapeutic exercises to strengthen core/spinal muscles to improve flexibility, range of motion and provide the spine with more optimal support.
Sometimes, bracing can also be helpful in stabilizing the spine while the fracture heals, although we don’t want patients in a brace for too long as it can cause a weakening of the spinal muscles.
When it comes to treatment for spondylolysis, part of the goal is to prevent further damage, such as the development of spondylolisthesis, when an affected vertebra slips out of place.
The spine is important not only because it gives the body structure and allows us to practice good posture and remain upright, it also allows us to engage in flexible movement; as such, the very design of the spine is based on movement.
Spondylosis is a term that references general degenerative changes in the spine, commonly caused by age, osteoarthritis, and/or degenerative disc disease; spondylolysis is a more specific diagnosis of a spinal injury, commonly involving a crack or fracture of the pars articularis caused by overuse.
While there are no treatment guarantees and every case is unique, treatment for spondylosis involves determining its underlying cause and crafting a customized treatment plan around it; treatment for spondylolysis involves rest and recovery while the crack or fracture heals and working towards increasing core muscle strength to improve spinal flexibility and range of motion.
Here at the Scoliosis Reduction Center, I believe in the merits of proactive treatment that prioritizes the health and function of the spine and integrates different treatment modalities such as physical therapy and condition-specific chiropractic care.