Spondylosis

• Spondylosis:

  • Spinal column degeneration and compression
  • Causes - osteoarthritis of the spine, trauma
  • Degeneration of vertebral body causes intervertebral space narrowing = compression
  • Most common in cervical and lumbar spine
  • Can sometimes be asymptomatic and be picked up incidentally on imaging
  • Any symptoms will depends on the are of the spine or nearby structures affected
• Cervical spondylosis:

  • Neck pain and/or stiffness
  • If causes stenosis this can cause myelopathy and/or radiculopathy
• Lumbar spondylosis:

  • Low back pain
  • Leg pain
  • If causes stenosis - less likely to get myelopathy as spinal cord ends at L1/L2 but can get radiculopathies
  • Lumbosacral nerve roots from the sciatic nerve - radiculopathy of these can cause sciatica
• Diagnosis:

  • Mostly clinical from history and examination
  • Get imaging if diagnostic uncertainty, atypical features or sudden worsening of symptoms
  • X-ray, CT or MRI
• Clinical exam:

  • Reduced range of movement
  • Paraesthesia and numbness
  • Cervical compression test - lateral flexion of neck causes neck and shoulder pain on same side
• Initial management:

  • Information and support
  • Psychological support
  • Exercise and muscle strengthening
  • Analgesia - topical NSAID, oral NSAID (consider PPI), short term weak opioid
• If initial management ineffective:

  • Refer to physiotherapist or MSK team
  • Behaviour change programmes
  • Joint support and braces
  • Intraarticular steroid injections
• Refer to surgeons if:

  • Significant impact on QOL
  • Diagnostic uncertainty/atypical features
  • Poor response to initial management
  • Sudden worsening of symptoms
  • Surgical options - removal of bony spurs, laminectomy, fusion
• Risk factors:

  • Nerve compression
  • Vertebrobasilar insufficiency
  • Spinal disc protrusion
  • Myelopathy