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How Osteoarthritis Affects the Spine
As a person ages, degenerative changes occur in his/her joints, including the spine which is a series of vertebral joints running from the base of the skull to the sacrum. These changes include thickening and calcification of the ligaments in the joints, inflammation and growth of bone spurs, and are collectively considered signs of osteoarthritis. Arthritis of the spine can affect any level from the neck (cervical) to the upper back (thoracic) to the lower back (lumbar) area.
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What is Spinal Stenosis?
As a result of the degenerative changes associated with osteoarthritis, the spinal canal containing the spinal cord and nerves may be constricted (a condition called stenosis), resulting in compression of the neural tissues. These usually occur in people over 50 years old. Although spinal stenosis can also occur due to spinal trauma and inflammation in younger people, that which related to aging is the more common cause of stenosis.
Osteoarthritic changes usually occur gradually and symptoms also manifest progressively according to the degree of constriction. Mild to moderate constriction can cause pain and limitation in motion at and below the level of the affected spinal region. Conservative treatment with pain medications and physiotherapy are usually effective in alleviating the symptoms.
What is a serious spinal stenosis? Severe compression of the spine due to constriction causes more than just pain and limitation of motion. Also, as the level of involvement of the spine moves upward, the more serious the complications can occur. The lumbar spine is most commonly affected, followed by the cervical area, and then the thoracic area.
When a patient has severe lumbar spine stenosis, he may experience:
- Pain, numbness, loss of coordination and weakness of the feet, legs and buttocks
- Pain may be radiating or constant, relieved by leaning forward or lying down
- Weakness when standing or walking short distances – relieves by resting
- Paralysis of both legs or paraplegia
- Bowel and/or bladder incontinence – rare, also called cauda equina syndrome
- Loss of sexual function (erection) in males
The areas above the buttocks are usually not affected; only those below the level of spinal involvement experience the symptoms.
When the patient has severe cervical spinal stenosis, he may experience these symptoms:
- Numbness, weakness or tingling in legs, feet, arms and hands
- Patient may drop things more often
- Weakness, incoordination and a tendency to fall
- Neck pain is not common but can occur
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Diagnosis and Treatment of Serious Spinal Stenosis
Severe degenerative changes related to arthritis are usually seen in x-ray images. However, the extent of spinal stenosis and severity of cord compression may be more properly evaluated with other imaging techniques such as CT scan, myelogram and MRI.
Conservative treatment using pain medications and physiotherapy are more effective for mild to moderate cases of spine arthritis. For serious spinal stenosis decompression of the spine with surgical methods is more effective.
Surgery must be considered when neurologic symptoms like numbness and weakness are present to prevent permanent loss of function or paralysis. This is also true to bowel and bladder problems which are more serious signs of nerve compression.
The goal of surgery, called laminectomy is to remove the pressure on the spinal cord and nerves so as to relieve pain and restore function. If the vertebrae are misaligned, spinal fusion may also be done to prevent cord damage. However, the procedure is not without risks, considering the delicate tissues involved and the general health condition of the elderly patients who are more commonly affected. Bleeding, blood clotting, infection and nerve damage are the more common complications of surgery which can prolong hospital stay and increase risk for mortality.
Other types of decompression surgery may also be done depending on the indication, such as laminotomy, foraminotomy, facetectomy, discectomy and corpectomy.
Although improvement of function and pain relief may be obtained after surgery, the aging process cannot be prevented, and degenerative changes will continue after treatment.
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SpineUniverse, “Spinal Stenosis: Lumbar and Cervical”, http://www.spineuniverse.com/conditions/spinal-stenosis/spinal-stenosis-lumbar-cervical
NIAMS, “Spinal Stenosis”, http://www.niams.nih.gov/Health_Info/Spinal_Stenosis/default.asp