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Arthritis - Osteoarthritis - Rheumatoid Arthritis - Ankylosing Spondylitis - Spinal Stenosis

There are many types of back and neck disorders that affect the majority of the population in the United States. Injury, aging, general health, and lifestyle may influence the development of some conditions. Most spinal disorders are known to result from soft tissue injury, structural injury, and degenerative, or congenital conditions.

Degenerative and Congenital Disorders
Degenerative disorders may develop as a result of the normal aging process and wear and tear. Just like a mechanical device the human body is subject to wear and tear from use. However, unlike machinery, the human body has the ability to heal or attempt to repair itself.

At birth the structural integrity of the spine, heart, lungs, and other organ systems is at its peak for future development. During mid-life early microscopic changes begin to appear that indicate the spine is aging. The spine does not deteriorate just because of age. Wear and tear is also responsible. Disorders such as arthritis (arth-rye-tis), spinal stenosis (spinal sten-oh-sis), and osteoporosis (os-t-o-pour-o-sis) do not develop overnight. Degenerative diseases may take years to develop and may be associated with past injury, abuse, body structure, or congenital problems.

Arthritis affects approximately 80% of people over the age of 55 in the United States. Injury, a weakened immune system, and/or hereditary factors can trigger the onset of arthritis. There are hundreds of types of arthritis that share similar symptoms including inflammation, joint pain, and progressive deterioration of joint surfaces over time. The joints may lose normal contour, excessive amounts of fluid may build up inside the joint along with pieces of floating debris. Arthritis may affect the joints in the spine, which enable the body to bend and twist. Part of the problem may be the body's response to arthritis, which is to manufacture extra bone to stop joint movement. The extra bone is called a bone spur or bony overgrowth.

 

Degenerative Disorders

 

 

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In medical terms, the extra bone is called an osteophyte (os-t-o-fight). Osteophytes may be found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The body's production of osteophytes is a futile attempt to stop the motion of the arthritic joint and deal with the degenerative process. It never completely works. The evidence of bony deposits can be found on an x-ray. A bone spur may cause nerve impingement at the neuroforamen (nu-row for-a-men). The neuroforamen are passageways through which the nerve roots exit the spinal canal. Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root. Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body.

Osteoarthritis (OA) (os-t-o-arth-rye-tis) is the degenerative form of arthritis. It is a progressive joint disease associated with aging. Many elderly people have some degree of osteoarthritis. It may be found in the knees, hips, or other joints. Spinal osteoarthritis affects the facet joints that enable the body to bend and twist. As the facet joints deteriorate, cartilage may become inflamed and start to fray like a well-used rag. During this process cartilage (car-til-ledge) breaks away from the joint surfaces. Cartilage fragments may begin to float in the fluid that lubricates the joint. Joints stripped of their cartilage are no longer smooth slick surfaces that enable friction-free movement. Joint bones begin to rub together while trying to work. The nerve structures in the joint become irritated and cause inflammation and pain. Osteoarthritis may trigger the formation of osteophytes. As previously mentioned, these bony spurs are the body's way of dealing with the disease. In the spine, osteophytes may cause disc space to narrow. When this happens the affected intervertebral disc may collapse.

Rheumatoid Arthritis (RA) (room-ah-toyed arth-rye-tis) is a progressive form of arthritis that can be painfully destructive. Visit Practical Pain Management, our sister site, for in-depth rheumatoid arthritis information, including how RA affects other joints in the body and how you can treat it.

RA may cause the interior joint tissues to swell and thicken. Over time, the affected joint disintegrates, leading to deformity. RA may appear during early middle age and is more common in women than men. The symptoms include fatigue, weakness, and loss of appetite, fever, and anemia. Upon rising, joints are usually stiff, swollen, and tender. Medication is available to help relieve pain and inflammation. Regular exercise helps joints to function.  Watch our slideshow of rheumatoid arthritis exercises and stretches.  Passive forms of physical therapy may help to increase joint mobility.

Ankylosing Spondylitis (an-key-low-sing spon-dee-lie-tis) is a chronic and progressive inflammatory disease of the spine. It is characterized by early sacroiliac joint (say-kro-ill-e-ak, sacrum) involvement followed by hardening of the anulus fibrosus and surrounding connective tissue along with arthritic changes in the facet joints. The disease may cause the spine to gradually lose flexibility and stiffen. The disease is hereditary.

Spinal Stenosis (spinal sten-oh-sis) Translated from the Greek language, stenosis means a narrowing of a normally larger opening, the spinal canal or neuroforamen (nu-row for-a-men, window) through which nerves exit the spinal column. This disorder is associated with aging. Some people are predisposed to spinal stenosis genetically or it may be caused by a congenital condition. If the neuroforamen are partially or completely closed, the spinal nerves become compressed or trapped. The symptoms of spinal stenosis include numbness, weakness, and sensations of burning, tingling, and pins and needles in the affected extremity such as the leg.

Spinal stenosis could be compared to wearing a pair of shoes that are a half size too small. The feet (nerves) react to the pressure by swelling (inflammation) that makes the shoes even tighter. The pain (nerve compression) can make walking difficult or impossible. Patients with spinal stenosis have found the pain eases when bending forward or sitting. Bending forward creates more space between the vertebrae that may temporarily relieve nerve compression.

Spinal stenosis may affect any part of the spine but is more prevalent in the lumbar spine. Lumbar spinal stenosis produces pain that may be felt in the buttocks, thighs, and calves when walking or standing. Cervical spinal stenosis affects the upper extremities and back. When severe, cervical spinal stenosis may affect the body from the neck down.

A CT Scan or MRI is performed to confirm that the patient's symptoms are caused by spinal stenosis. When necessary a surgical procedure called a foraminotomy (for-am-not-toe-me) is performed to enlarge the size of the window to help relieve nerve compression.

Foraminal Stenosis (foe-ray-min-al sten-oh-sis) is similar to spinal stenosis but is singled out because it primarily affects one or more vertebral foramen. In a normal spine nerve roots have enough room to slip through the foramen. However, age and disease may affect the foramen by clogging the openings with debris that trap and compress nerves. The symptoms of foraminal stenosis include numbness, weakness, and sensations of burning, tingling, and pins and needles in the affected extremity (e.g. leg). Not every stenosis is critical but if ignored, nerves may die that may cause a loss of function. Functional loss may involve the ability to feel (sensory) and move (motor). If nonsurgical treatments are unsuccessful in relieving the patient's symptoms, surgery may become an option. The procedure is called a foraminotomy.

Degenerative Disc Disease (DDD) affects the vertebral discs. During spinal flexion and extension, the discs absorb and distribute pressure and excessive stress created by movement. It is natural for some disc wear and tear to occur with age and movement.

When the spine is x-rayed the disc spaces between the vertebrae may appear narrow indicating DDD. Loss of disc hydration is one of many biochemical changes that occurs with age and may cause discs to thin, shrink, or collapse. A similar chemical change occurs as a tire ages. As the tire loses its resilience its original form is compromised. The disc may shrink in size, wrinkle, or crack. Pieces of the disc may break away (fragments) and cause nerve irritation. Thin, collapsed, or broken discs reduce the size of the neuroforamen formed between the upper and lower vertebral discs. As the neuroforamen is reduced in size, compressed nerves begin to swell and signal pain. T

The neuroforamen could be compared to brakes on a car. In this scenario the vertebral discs are the brake pads that form a cushion between the foot pedal (top vertebral body) and the wheel (bottom vertebral body). Age, abuse, and wear and tear cause the brake pads to thin or even disintegrate. What happens? The brakes squeal (pain) and may not stop the car. The driver of the car feels the affects of the faulty brakes. A normal amount of wear and tear is expected and acceptable. The same is true of the spine. With proper nutrition, regular exercise, and prevention the body can be in good shape at any age.

Osteoporosis (os-t-o-pour-o-sis) is known as the silent degenerative disease. It is labeled silent because in the early stage of the disease the patient may be free of symptoms. However, as the disease progresses, bones gradually begin to resemble a well-used sponge, thin and porous. Bone mass and density (strength) is lost.

 

Osteoporosis

 

 

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Although spinal osteoporosis is more common, osteoporosis can affect any bone in the body. It makes bones susceptible to fracture. It could be said that osteoporosis begins when the body makes more calcium withdrawals than deposits resulting in bankrupt bones. The symptoms of spinal osteoporosis include chronic pain, loss of mobility, and an alternation in appearance. Patients may look frail, bent over and shorter. Chronic pain may result from spinal muscles forced to handle the spine's load. Daily chores like making the bed, removing food from the oven, or even embracing a loved one can cause vertebrae (ver-ta-bray) to break.

Deformities may develop as the bones in the spine become more porous and weaker. Bone breakdown may eventually lead to compression and crush fractures as well as a hump back (excessive kyphosis). Loss of bone strength may cause spontaneous fracture. The patient's body weight alone may cause vertebrae to collapse leading to compressed nerves. As vertebrae collapse the patient loses height. Internal organs may be forced out of their normal position. Osteoporosis can be an insidious disease eventually causing health to deteriorate.

Osteoporosis is a normal part of aging for women and men. It is important to know the risk factors and reduce them. Smoking, alcoholism, heavy use of laxatives, stress, diabetes, menopause, inactivity, and unhealthy dieting are factors known to accelerate the progression of the disease. Women who smoke produce lower levels of estrogen. Plus smoking interferes with calcium absorption necessary for strong healthy bones. Alcoholics, women or men, usually have less bone mass because calcium absorption is hindered. Stress can be an undermining factor because it may stimulate adrenal hormone production that could cause calcium to be passed during urination.

Women are prone to osteoporosis because their bones are smaller and contain less mass than a man's bones. Additionally, during menopause estrogen levels are affected. Estrogen helps to maintain sufficient calcium in the skeletal system. Further, women usually live longer than men therefore, women have more time to develop osteoporosis. A Bone Mineral Density (BMD) test is a simple, painless, and quick noninvasive test for osteoporosis. This test measures the density of bone.

If signs of osteoporosis are found the physician may prescribe medication to help control the disease. Since it can take years for bone to gain strength, treatment may be started when the patient is in their 60s. The medication is available in several forms; pill, nasal spray, or transdermal patch. In some cases the medication helps to prevent spontaneous fractures or a broken hip or rib from a minor fall.

Regular exercise is especially important at any age for many reasons. Physical activity stimulates bone to become denser, increases circulation that nourishes bone, and helps to maintain healthy hormone levels. Weight bearing and resistance exercises such as walking build strong bones. Before starting any exercise program, see your physician.

Spinal Tumors are rare. The physician is interested in determining the cause of the tumor, if there is a past history of cancer, and relieving associated pain. If the patient's primary condition is breast or lung cancer it is possible for the cancer to metastasize (spread) to the spine. Tumors can occur in anyone without a history of disease. Fortunately not all spinal tumors are malignant (cancerous).

This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.

Updated on: 05/09/11
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