Overview of Spine Osteoarthritis

Osteoarthritis can affect any joint in the body, including the spine. Osteoarthritis of the spine occurs when there is deterioration in the discs between the vertebrae. Early diagnosis and treatment help people with osteoarthritis of the spine manage their symptoms.

Causes

The deterioration in the discs between the vertebrae of the spine can be caused by:

• repetitive trauma to the spine from accidents, sports injury, work activities, or poor posture
• aging of the spinal structures beginning when a person is in their 30s
• overweight or obesity, which puts more burden on weight-bearing joints like the spine
• a family history of osteoarthritis, particularly of the spine
• an association with other diseases such as rheumatoid arthritis, gout, diabetes, and infections

With primary osteoarthritis of the spine, the cause is not known and it is usually attributed to the aging process. When the cause is known (i.e., injury, other diseases, obesity), it is referred to as secondary osteoarthritis of the spine.

Diagnosis

Any patient who has back pain that persists for more than two weeks should consult with a doctor. The diagnosis of osteoarthritis of the spine will follow:

• a medical history
• an evaluation of symptoms
• a physical examination
• x-rays or other imaging studies of the spine
• other tests (such as blood tests, bone scans, MRIs) may be ordered to rule out other conditions

X-rays alone do not yield enough information to be the only diagnostic tool used. Most people who are over 60 years old have degenerative changes in the spine indicative of osteoarthritis, but not all experience pain or stiffness in the spine. The diagnostic process is of most value when patients have symptoms and the doctor is able to track down the reason for those symptoms. An accurate diagnosis is needed so appropriate treatment can begin.

Symptoms

The deterioration of the discs between the vertebrae of the spine is usually a gradual occurrence and leads to the narrowing of the spaces between the vertebrae. Bone spurs or osteophytes typically develop. As bone begins to eventually rub on bone, the facet joints (also known as vertebral joints) become inflamed and there is more progressive joint degeneration. The surface of the facet joints is covered with articular cartilage. The symptoms that result include:

• pain in the back or spine
• stiffness of the spine
• loss of flexibility in the spine

Osteoarthritis can occur in the cervical (neck), thoracic (mid-back), or lumbar (lower back) regions of the spine. With cervical osteoarthritis, neck pain may radiate into the shoulder or down one of the arms. Osteophytes in the cervical region can cause nerve compression and weakness in the arms. Osteoarthritis pain in the thoracic region of the spine is usually provoked by movement of forward flexion and hyperextension.

Osteoarthritis of the lumbar region of the spine is characterized by morning stiffness (for about 30 minutes) and usually involves more than one vertebra. Symptoms can worsen after physical activity, repetitive movements, and sitting for prolonged periods. Back pain can become a recurring problem.

Treatment

There are non-surgical and surgical treatments for spine osteoarthritis:

• medications including NSAIDs, acetaminophen, and opioid analgesics
• physical therapy
• exercise
• weight loss
• heat or cold therapy
• water therapy
• massage
• transcutaneous electrical nerve stimulation, or TENS
• bracing

Most people with degenerative disc problems do not require surgery. If conservative measures fail after a period of time, surgical options exist including lumbar laminectomy, discectomy, and spinal fusion.