Spondylosis: How Doctors Treat Spinal Osteoarthritis
A thorough physical examination reveals much about the patient's health and general fitness. The physical part of the exam includes a review of the patient's medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include:
- Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm
- Range of motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.
- A neurologic evaluation assesses the patient's symptoms, including pain, numbness, paresthesias (eg, tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.
X-rays and Other Tests
Radiographs (x-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but they are not as useful as a CT scan or MRI. A CT scan may help reveal bony changes sometimes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities.
Discography seeks to reproduce the patient's symptoms to identify the anatomical source of pain. Facet blocks work in a similar manner. Both are considered controversial.
The physician compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. The results from the examination provide a baseline from which the physician can monitor and measure the patient's progress.
Nonsurgical treatment is successful 75% of the time. Some patients may think because their condition is labeled "degenerative" they will not be able to be active. This is seldom the case. Many patients find their pain and other symptoms can be effectively treated without surgery.
During the acute phase, anti-inflammatory agents, analgesics, and muscle relaxants may be prescribed for a short period of time. The affected area may be immobilized and/or braced. A soft cervical collar may be used to limit movement and alleviate pain. Lumbosacral (low back, sacrum) orthotics may decrease the low back load by stabilizing the lumbar spine.
A course of physical therapy may include heat, electrical stimulation, and other modalities to help ease muscle spasm and pain. During physical therapy, the patient learns how to strengthen their paravertebral (back) and abdominal (stomach) muscles to lend support to the spine. Isometric exercises can be helpful when movement is painful or difficult. Exercise in general helps to build strength, flexibility, and increase range of motion.
Lifestyle modification may be necessary. This may include an occupational change (eg, from manual labor), losing weight, and quitting smoking.
Seldom is surgery performed to treat spondylosis. Most patients respond well to nonsurgical treatment for spinal osteoarthritis.
If the patient experiences a neurologic deficit (such as bowel or bladder problems), surgery may be considered. The doctor considers many factors about the patient's health before surgery is recommended. Some of these factors include the patients age, lifestyle and severity of the patient's spinal disorder. A spinal specialist can determine if surgery is the best treatment for the patient.
Always follow the instructions provided by the doctor or physical therapist. This includes:
- Take medication as directed. Report side effects immediately to your doctor.
- Follow the home exercise program provided by the physical therapist.
- Avoid heavy lifting and activities that aggravate pain and symptoms
- Maintain a healthy weight.
- Stop smoking.
- If symptoms persist or change, contact your doctor.
Discuss questions or doubts you have about modifying your daily activities with your doctor or physical therapist. He or she will be happy to provide information to help speed recovery.