Spinal Arthritis

Spinal arthritis associated with the degeneration of the spinal facet joints has been implicated in the development of neck and back pain.  These joints link each vertebra together and a pair of these joints are located on the backside of the spinal column.  The facet joints are responsible for providing some load bearing activity as well as providing stability to the spine.  In addition, they restrict excessive rotation of the spine.

Like most skeletal joints, the facet joints fit together and glide smoothly without excess friction being developed.  If sustained pressure begins to build within the joints, the cartilage on the joint surfaces begins to wear away creating joint inflammation.  This entire degenerative process is referred to as spondylosis or spinal arthritis.

Spinal arthritis develops as a result of degenerative disc disease causing increased compression in the facet joints.  As the disc begins to lose its height, the joint become more and more compressed.  An animated description of this process can be found here: Spinal Arthritis

Other potential causes of spinal arthritis include fractures, torn ligaments, and muscular imbalances all of which cause abnormal movement and alignment, resulting in greater pressure on the facet joint surfaces.

The body’s natural response to this excess movement and pressure is to lay down more bone (bone spurs) to stabilize the spinal segment. As these spurs form around the edges of the facet joints, the joints become enlarged, also known as facet joint hypertrophy, eventually resulting in spondylosis or arthritis.

Spinal arthritis develops slowly over a long period of time but is found in all ages.  A recent study of over 3500 patients identified the presence of spinal arthritis in 24% of less than 40 year olds, 45% of 40 to 50 year olds, 74% of 50 to 59 year olds, 89% of 60 to 69 year olds, and 69% of greater than 70 year olds. 

The highest prevalence of spinal arthritis occurs at the L4,5 level followed by L5,S1, L3,4, and L2,3.  Women tend to develop spinal arthritis slightly more often than men. 

Symptoms of Spinal Arthritis
Although recent research has been unable to correlate back pain with spinal arthritis, symptoms associated with spinal arthritis is usually worse after resting or sleeping.  In addition, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint due to the “bone on bone” relationship of the facet joints.

Low back pain is usually experienced in the center of the low back and can spread into one or both buttocks.  Sometimes the pain will spread into the thighs, but rarely travels below the knee. 

Symptoms associated with nerve irritation such as numbness and tingling, sciatica, muscle weakness, and diminished reflexes. are usually not experienced unless the spinal arthritis has caused a bone spur that is irritating an adjacent nerve root. 

Diagnosing Spinal Arthritis
A diagnosis of spondylosis is made by correlating the findings of the clinical examination with the results obtained from diagnostic imaging.  Imaging studies of x-rays, MRI, or CT scan are often used to diagnose spinal arthritis.  Another procedure used to diagnose spinal arthritis is a facet joint injection where a numbing agent is injected into the facet joint.  If the pain goes away, the joint is usually implicated as the source of the back pain.

Treatment of Spinal Arthritis
Initial treatment for spinal arthritis usually includes rest and the use of anti-inflammatory medication (NSAIDs), muscle relaxants to reduce muscle spasm, and occasionally the use of oral steroids to reduce inflammation and pain.

Other nonsurgical treatment options for spinal arthritis include physical therapy, chiropractic, or facet joint injections.  Although there is no strong evidence that facet joint injections work, they seem to have some good short-term benefits with few negative side effects.

Surgery for Spinal Arthritis
Because spinal arthritis has been identified as a primary source of chronic low back pain in about 15% of the cases, spinal surgery is rarely considered. However, if conservative treatment has failed and the back pain is limiting function, surgical intervention may be considered.  The two primary surgical options for spinal arthritis include facet rhizotomy and posterior lumbar fusion.

Conclusion
Despite the overwhelming evidence to the contrary, spinal arthritis has been blamed as a primary source of back pain. According to the most up to date medical research, the development of spinal arthritis is inevitable and has no predictable relationship to low back pain. 

The key to maintaining a healthy spine is movement.  The basic premise of the Erase Your Back Pain program is to address movement deficiencies that have been shown to precipitate spinal arthritis.

Once these movement deficiencies are addressed, the degenerative process can be slowed and normal function resumed.

For additional information please see:
Facet Joint Injections
Backl Surgery
Low Back Pain
Degenerative Disc Disease

Written by Malton A. Schexneider, PT, MMSc