Spinal Osteoarthritis

What is Spinal Osteoarthritis?

Osteoarthritis is a common health issue that affects the joints in your body. Over time, it can develop into a painful and restrictive condition, significantly affecting movement. Remarkably, about 80% of Americans experience lower back pain at some point in their lives. It’s one of the main reasons people visit healthcare providers in the United States, with over 45 million recorded visits in 2006 alone. A significant cause of this chronic lower back pain is spine osteoarthritis.

For many patients, the pain caused by spine arthritis goes away on its own and only requires minimal treatment. However, chronic back pain can involve significant healthcare costs. In fact, in 2016, Americans spent an estimated $380 billion on treatments for lower back and neck pain. That’s about 17.9% of the country’s total economy!

Low back pain and spine arthritis are significant health problems, leading to disability and a decrease in quality of life. With the rising numbers of obesity and longer life expectancy, cases of back pain are increasing. Additionally, lower back pain is responsible for an estimated 149 million missed workdays each year in the United States. The lost earnings from these missed days have a substantial impact on our economy.

Identifying the exact cause of low back pain can be challenging because of the complexity of the nervous system in the spine and its surrounding structures. In around 85% of cases, the source of back pain remains unknown. Making the diagnosis even more complicated is the fact that x-ray images of spine osteoarthritis can’t always accurately show the real cause of a patient’s pain. This discrepancy can lead to treatment options that may not effectively improve symptoms.

Arthritis can affect any joint in the body but is more likely to affect those that bear weight, including the joints in the spine. The spine has many functions: it protects the spinal cord, supports body weight, and allows movement. The spinal cord is made up of a three-joint complex. This complex includes two facet joints, which are the connections between the bones of the spine, and one disc in between each set of bones. These three parts form a motion segment of the spine that can degenerate, or wear down, over time. This degeneration can lead to bone spurs, facet joint osteoarthritis, and a reduction in disc space.

Specifically, spine osteoarthritis involves the breakdown of the discs in the spine and the formation of bone spurs, which are small growths of bone.

What Causes Spinal Osteoarthritis?

Spine arthritis, or osteoarthritis of the spine, has historically been thought of as a result of “wear and tear”. The traditional thinking was decline over time would lead to the development of bone spurs (osteophytes) and loss of cartilage, the flexible tissue that cushions joints. However, recent understanding suggests that the causes of spine arthritis are complex and can be due to several factors.

These include genetics (the genes a person inherits), epigenetics (changes in gene activity not caused by changes in DNA sequence), elements of a person’s diet, their gender, ethnicity, age, muscle strength, physical activity levels, and work-related habits. These factors together can lead to low-level, chronic inflammation and further degenerative changes in the spine.

Overuse of muscles, especially with incorrect joint movements, may also lead to injury, changes in the alignment of the joints and worse arthritis. Certain congenital (present from birth) abnormalities such as differing angles in the curve of the spine can also contribute to the development of spine arthritis.

In terms of genetics, researchers have identified more than 80 gene mutations that are involved in osteoarthritis. One of the most significant is the 143383 nucleotide polymorphism, a change in one of your DNA building blocks, that plays a role in developing and repairing joints, particularly those in the neck and lower back.

Epigenetics can contribute to your body’s ability to adapt to changes in your cells’ environment more quickly. For example, changes to certain genes can play a large role in maintaining cartilage, and can even speed up its destruction.

Age is a significant risk factor for osteoarthritis, as the ability of cartilage to repair itself declines as we get older. Cartilage cells have a limited lifespan and ability to replicate, leading to an overall decrease in cartilage, predisposing joints to damage, particularly under mechanical stress or physical exertion.

Gender and ethnicity are influential too. The curvature of the lower spine, or lumbar lordosis, varies between men and women, and can increase the load on the joints, leading to degenerative changes. This is particularly significant in women and older men.

Ethnic variation in joint flexibility does not seem to carry a higher or lower risk for the development of radiographic (visible on X-ray) arthritis, although there appears to be a link between more flexible joints and lower back pain.

There are also diet and lifestyle related factors that contribute to the development of osteoarthritis. The risk factors for metabolic syndrome, which include central obesity, diabetes, high blood pressure, and elevated cholesterol, are all independently associated with the likely onset of osteoarthritis. Problems with the blood supply to bones (ischemia) can lead to cell death in bone and cartilage, making it more likely for damage to occur.

Obesity itself is of particular concern as it also triggers the release of pro-inflammatory cells called cytokines, as well as leptin, a protein involved in regulating energy balance, which is released by fat cells. This can contribute directly to arthritis. The presence of leptin correlates with the severity of cartilage destruction. Additionally, substances produced by cartilage cells called reactive oxygen species can also cause damage. Taking in antioxidants, including vitamins C and K, can help in preventing arthritis.

Risk Factors and Frequency for Spinal Osteoarthritis

Spine osteoarthritis – a condition that affects the joints in the spine – is commonly observed on x-rays. This condition is more prevalent in people over the age of sixty, with 95% of men and 70% of women showing signs of arthritis.

• Over 80% of people over the age of 55 have cervical spine osteoarthritis, which affects the neck region.
• Facet joint arthritis – arthritis affecting a particular type of joint in the spine – is present in one out of five individuals between the ages of 45 and 65 and more than half of people over 65.
• Lumbar spine osteoarthritis, which impacts the lower back, affects roughly 30% of men and 28% of women aged 55 to 64. It most commonly impacts the L4-5 and L5-S1 levels of the spine, since these levels bear more weight and have more joint movement.
• Related lower back pain is found in over 20% of men and 22% of women between 45 and 64 years old.
• Most individuals in the 45 to 64 age range (67%) and a large majority of those over 65 (89%) show signs of facet joint arthritis on medical imaging.
• It’s also worth noting that spine osteoarthritis may affect different ethnic groups differently – with lower rates found in people of Asian descent compared to those with white backgrounds. Males tend to show more advanced osteoarthritic changes than females.

Signs and Symptoms of Spinal Osteoarthritis

Osteoarthritis of the spine often comes with symptoms like pain, stiffness, and limited motion, along with pain referred to other areas. The pain a person feels depends on where their spinal issue is located. For instance, problems with the middle and lower neck joints can lead to pain near the shoulder blades and shoulders. Issues with the top of the spine can cause pain at the back of the head and sometimes headaches. Lower back problems can create pain in the buttock and thigh region. If there is a pinching of the nerves in the lower back, it can result in pain radiating down the leg, above the knee. If the leg pain extends below the knee, it’s likely due to nerve irritation or compression, which can also impact movement, sensation, and reflexes. Examining the patient can rule out other causes of spinal pain like tumours, slipped discs and narrowing of the spine.

Osteoarthritis itself tends to cause pain that can be pinpointed and is on one side of the body. This type of pain can be replicated by touching the affected joint and is often relieved by bending forward. If radicular symptoms are present, they typically do not extend below the knee. Pain experienced during bending backwards and twisting from a standing position could suggest the facet joints have been affected.

In many people with osteoarthritis in the neck area of the spine, the pain can be felt in the shoulder, back of the head, and front of the chest. If the pain continues for longer than one to two weeks, or there are additional symptoms such as numbness, tingling, weakened grip strength, fever, or crunching sounds during movement, then more tests may be needed.

During the initial evaluation of spinal osteoarthritis, certain warning signs, or “red flags”, should also be taken into account. These include numbness, loss of bowel or bladder control, fever, chills, or loss of feeling in the “saddle” area (the area that would come into contact with a saddle if you were riding a horse).

• Inspection and touch examination of the affected area
• Active and passive movement testing of the spine
• Check for pronounced or reduced curve of the lower back or upper back
• Assessment of the patient’s walking style and posture

If there is tenderness over the bony part of the spine it needs to be distinguished from tight paraspinal muscles. Testing of muscle strength, sensation and deep tendon reflexes might be needed depending on the location of the patient’s pain. If there is a concern about spinal cord disease, the patient might show symptoms such as stiffness, unsteady walk, exaggerated reflexes, or a positive Babinsky sign (toes fan out when the sole of the foot is stroked). Additional tests might be required if radiculopathy (spinal nerve root irritation) is suspected, like the Spurling test and straight leg raise.

Testing for Spinal Osteoarthritis

To diagnose spine osteoarthritis, a thorough patient history and physical examination are crucial. However, it’s equally important to rule out any other serious reasons for back pain, such as infection, tumors, inflammatory diseases, nerve damage, or aortic aneurysm or tearing. More advanced tests or imaging might be required in order to confirm or rule out these conditions.

One common test to evaluate osteoarthritis of the spine is a plain film imaging test, also known as an X-ray. This type of test is relatively inexpensive and easy to carry out. It’s a suitable choice if back pain has been continuous for more than six weeks and there are no symptoms of nerves being affected, such as sharp or shooting pain.

However, if there’s concern about systemic diseases or trauma, or if the patient’s symptoms suggest a possibly serious infection, tumor, or severe nerve issues, more advanced imaging tests such as a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan might be needed. These tests can give a more detailed look at the spine and help doctors determine the exact cause of the back pain. A slipped disc, for example, could be causing the pain and typically occurs in the lower neck or lower back region. Particularly in older patients, it’s advisable to opt for these advanced imaging techniques sooner if the pain is persistent.

Additionally, certain procedures, involving guided injections to diagnose pain originating from the spinal joints, have been found to be effective. These include medial branch blocks and dual comparative anesthetic blocks.

Treatment Options for Spinal Osteoarthritis

The various treatments available for spine osteoarthritis include traditional medication, physical therapy, and certain surgical procedures. The right treatment for a patient depends on a variety of factors, such as the cause of the osteoarthritis, how long the patient’s been in pain, if there are any neurological symptoms, and what the results of a physical exam are.

Spine osteoarthritis is a condition where the cartilage of the joints and the disc in the spine wear down. The American College of Physicians Clinical Guidelines Committee (ACPCGC) guideline provides a guide for managing lower back pain with the goal of avoiding unnecessary costs. For acute or subacute non-radicular low back pain, first-line treatments recommended by the ACP include methods like superficial heat, massage, acupuncture, or spinal manipulation.

Acute back pain is pain that lasts under four weeks, subacute lasts between four to 12 weeks, and chronic back pain lasts longer than 12 weeks. Non-interventional therapies like exercise, cognitive behavioral therapy (therapy that helps patients understand and manage their thoughts and feelings), physical therapy, acupuncture, massage, along with others, can help lower back pain.

Exercise therapy, particularly exercises conducted on land, can help in increasing bone mineral density in the lumbar spine (lower back). For patients with obesity, who might find exercising difficult, doctors should create personalized treatment plans, including supervised exercises to increase mobility, or water-based exercises. According to studies, aquatic exercises can help prevent age-related bone deterioration.

Apart from exercise, a balanced diet and nutritional supplements also play a crucial role in managing spine osteoarthritis. High intake of saturated fats may speed up osteoarthritis, while monounsaturated and polyunsaturated fats can slow down its progression. Therefore, reducing consumption of omega-six fatty acids and increasing intake of omega-three fatty acids can be beneficial.

Weight management is essential as obesity is a risk factor for osteoarthritis. Every five kilograms of weight gain is associated with a 36 percent increased risk of developing osteoarthritis. Meanwhile, losing weight can reduce joint pain and improve quality of life. In certain cases, where the patient finds it hard to lose or maintain weight loss, they might be referred to a bariatric surgeon for surgical weight loss interventions.

Additionally, physical therapy can also be used to improve pain and function. Physical therapy-based exercises, such as those that focus on increasing flexibility and addressing lumbar stabilization and spinal stenosis, can significantly benefit patients with both acute and chronic spinal pain. Furthermore, yoga can also be efficacious in dealing with chronic lower back pain.

For those with chronic lower back pain associated with osteoarthritis, medications like acetaminophen and NSAIDs can help manage the pain. Aerobics, weight-bearing, and resistance exercise can increase lumbar spine bone mineral density in postmenopausal women. Increased intake of vitamins D and K along with controlled diet can help manage osteoarthritis. Spinal manipulation is a viable treatment option for those with acute and chronic back pain.

In more serious cases, invasive techniques may be necessary, which can include injections, acupuncture, and surgical interventions. However, surgery is reserved for specific cases, where there is significant structural damage, neurological symptoms, or non-operative intervention has failed. In certain cases like herniated disc, spondylolisthesis, or debilitating back pain, surgical interventions might be required. However, before any surgical intervention, various factors like smoking status, use of NSAID, circumstances of the patient need to be evaluated.

Surgical treatment for spine osteoarthritis can result in significant reductions in pain, but the results can vary and more research is necessary. Lastly, an important condition to be aware of is cauda equina syndrome (CES), in which there is severe compression of the nerves at the base of the spine, leading to severe pain and other symptoms. It requires urgent surgical management.

What else can Spinal Osteoarthritis be?

When it comes to diagnosing the cause of back pain, there are several possible conditions to consider. These conditions largely depend on the region of the back where the pain is located.

For instance, in the neck area, the following could be the source of the pain:

• Rheumatic diseases like fibromyalgia, arthritis, or degenerative joint disorders
• Injuries from trauma like fractures or soft tissue damage
• Regional conditions like skeletal infections, torticollis syndrome, or a synovial cyst
• Bone conditions such as Paget’s disease, osteomalacia (softening of the bones), osteoporosis, or a metastatic tumor
• Neurological causes such as meningitis, cerebral palsy, or paralysis of the neck muscles

Many underlying factors can also cause lower back pain, with most of them being mechanical (related to the spine’s structure). For example, the most common cause of acute back pain is a muscular issue like a lumbar strain or sprain, which accounts for 70% of such cases.

Again, the cause of back pain varies with the area of the back. For thoracolumbar back pain (affecting the middle and lower back region), possible causes can be:

• Mechanical issues like a herniated disc, spinal stenosis, spondylolisthesis, or a fracture
• Non-mechanical issues like cancer, infections, or inflammatory conditions
• Visceral diseases affecting the pelvic organs, kidneys, aorta, or the digestive system

What to expect with Spinal Osteoarthritis

It’s a fact that almost 80% of those living in the United States will experience low back pain at least once in their lives. On top of that, nearly a quarter of people might develop ongoing back pain after they first experience it. Interestingly, some individuals who show signs of arthritis in their back on x-rays don’t feel any pain. The spine is complex, making it challenging to find out the exact cause of back pain. In fact, less than 15% of back pain cases have a clear cause, making treatment difficult.

Neck pain is also common, with over a third of the population experiencing it at some point. As we age, arthritis-related changes in the neck become more common. However, most incidents of neck pain are temporary and may not last longer than a week, and sometimes people don’t even recognize it as neck pain.

Osteoarthritis, a long-term disease that causes joints to deteriorate over time, doesn’t usually cause symptoms. Arthritis is associated with aging, and how it affects a person’s health largely depends on how severe their osteoarthritis is. For instance, serious lower back pain from arthritis and narrowing of the spinal canal may need surgical treatment. Those with severe arthritis-related back pain that requires surgery generally have a tougher time recovering than patients with less severe symptoms.

Possible Complications When Diagnosed with Spinal Osteoarthritis

Osteoarthritis, a type of joint disease, can result in a number of complications as it progresses. When it affects the spine, it can lead to pain, functional problems, and disability. Doctors note that osteoarthritis can result in several conditions such as spinal stenosis (narrowing of spaces within the spine), herniated discs (discs that bulge out), myelopathy (spinal cord injury), radiculopathy (nerve root injury), spondyloarthritis (inflammation of the spine), and spondylolisthesis (one vertebra slipping over another).

Despite most back pain cases being non-life-threatening and short-term, a sizeable number of patients initially seen at a GP clinic get referred to the hospital. In fact, in the United Kingdom, 10 to 20 percent of the 2.2 million annual visits for low back pain at a primary doctor’s office result in a hospital referral.

Spondylosis, a complication of osteoarthritis, can lead to radiculopathy, myelopathy, and vascular impingement (pressure on blood vessels). Spinal stenosis can result in two clinical conditions, namely cervical myeloradiculopathy (a condition affecting the neck, spinal cord, and nerve roots) and lumbar neurogenic claudication (a condition causing pain and/or tiredness in the legs). Lumbar spine stenosis can cause continuous or on-and-off pain, weakness, and skin sensation changes, which are increased when standing or walking and reduced when sitting or lying down.

About one to two percent of 35 to 45-year-olds experience persistent low back pain due to herniated discs.

One common outcome of spine degeneration is degenerative spondylolisthesis, a condition most often seen affecting the L4 and L5 vertebrae. It involves one vertebra sliding over another due to a weakened joint. If severe, this might require emergency surgery.

Complications of Osteoarthritis:

• Pain, functional issues, and disability
• Conditions such as spinal stenosis, herniated discs, myelopathy, radiculopathy, spondyloarthritis, and spondylolisthesis
• Surgical emergencies due to severe spondylolisthesis
• Chronic low back pain in a percentage of the population
• Cervical myeloradiculopathy and lumbar neurogenic claudication due to spinal stenosis

Preventing Spinal Osteoarthritis

Low back pain is a common problem that most people will experience at some point in their life. It’s important for healthcare professionals to help patients understand this condition and the different ways it can be treated to prevent it from becoming a long-term issue. Creating a personalized healthcare plan is critical in this understanding. The healthcare provider and the patient should work together to decide on the best course of action based on the patient’s individual needs.

All educational efforts should cover essential things like understanding the disease itself, as well as providing emotional support, considering influences from the individual’s social life, and strategies for managing the condition oneself. Especially, for patients with spondyloarthritis of the spine – a type of arthritis that affects the spine – understanding the diagnosis, what to expect in the future, and how to manage the condition is important.

A study found that patients often wanted to know more about how to manage the condition themselves, how to deal with the emotional aspect, and how the disease works in the body. It’s important for patients to take an active role in making decisions about their health. Focusing on things like regular physical activity, managing weight, and a healthy diet are very important.

Healthcare professionals should help patients understand the various treatment options available for back pain. This can help patients make informed decisions about their treatment. Today, there are many digital resources healthcare professionals can give to patients for more information, such as websites, audio and video material online, and e-learning modules. Health professionals can also use tools like the Educational Needs Assessment Tool, allowing them to better understand the information their patients want to know about the disease, and tailor their educational efforts accordingly.