Spondylosis/OA definition etc

• Spondylosis/OA:

  • describes degenerative changes in Intervertebral discs, intervertebral bodies and facet joints of the spine
  • Can progress onto foraminal and canal stenosis, degenerative spondylitis or cauda equina syndrome
  • lumbar region most effected - high exposure to mechanical stress on how load goes through the spine
  • Normal process of aging: 80 - 90% of individuals between 45 - 60 yrs demonstrate osteophytes in lumbar spine so can be diagnosed with secondary illness
  • Not always painful - degenerative changes may present in younger pts without any trauma or history there should be a problem
• • the degenerative process in which OA mainly affects the lumbar spine is through affecting the vertebral bodies, the intervertebral foramen and the facet joints
• Lumbar Joints:

  1. Increased in load on joints, esp facet joints
  2. Subchondral bone hypertrophy
  3. Osteophyte formation
  4. Disc/cartilage degeneration
  5. Inflammatory mediators → Nociceptor activation (may not always be present if theres no current/ongoing inflammation within the joint)
• Clinical Presentation of Spondylosis / OA - History and MOI:

  • Insidious onset LBP: pain is vague and often non specific
  • Could also be secondary to trauma
  • pts maybe 55 yrs +
• Clinical Presentation of Spondylosis / OA - Subjective Features:

  • Can present without paraesthesia/anaesthesia/red flags, but beware of a progressing pathology - always ask special questions
  • Morning stiffness lasting less than 30 minutes
  • Aggs: prolonged sitting (due to intervertebral disc degeneration) and standing (facet joint OA)
  • Eases: walking
• Clinical Presentation of Spondylosis / OA - Objective Features:

  • Decrease in ROM - due to stiffness
  • Poor quality of movement - due to osteophytes formation
  • Stiff end feel - feature of arthritic joints
  • Posture? - any changes due to decrease ROM?
  • Could have neurological changes if progressive
• Clinical Presentation of Spondylosis / OA - Key impairments:

  • Unable to sit for a long time / aggravators in resting positions
  • Pain
  • Reduced ROM - probably mostly when leaning forward or backwards
• Clinical Presentation of Spondylosis / OA - Does this patient warrant a scan?

  • if we thought they had any red flags
  • if we thought they had any neurological signs and symptoms and if they were progressive