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Types
The types of spondylosis are:
• Cervical spondylosis.
• Lumbar spondylosis.
Cervical spondylosis:
It is characterized by the narrowing of the spinal cord. It can
lead to cervical spondylitic myelopathy through stenosis which
is related pressure on the spinal cord. Stenosis is because of
the misalignment of the vertebrae or degenerating disks. Spinal
stenosis is the narrowing of the spinal cord.
Lumbar spondylosis: It refers to the narrowing of the spinal
canal. The symptoms of these are associated with various
characteristics of disorders such as spinal stenosis,
spondylolisthesis, disc herniation, sciatica etc.
The various regions affected due to spondylosis are given below
• Bone and ligaments.
• Thoracic spine.
• Facet joints.
• Cervical spine.
• Lumbar spine.
• Intervertebral discs. |
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Bone and
ligaments: The blood supply to the vertebrae is
compromised by the bone spurs which form adjacent to the end
plates. These end plates are further stiffened due to sclerosis
(thickening of the bone under the end plates). The degenerative
changes cause the ligaments, which are fibrous tissue connecting
spinal structures like vertebrae and protects against the
extremes of motion to loose their strength. The primary spinal
ligament may harden and fold behind towards the spinal cord
membrane.
Thoracic spine: Pain due to
the degenerative changes is further prompted by hyperextension
or forward flexion. Pain in the thoracic spine is associated due
to this flexion.
Facet joints: Each vertebral
body consists of four facet joints that work as pivot. Facet
joints are otherwise called as zygapophyseal joints. These
joints are mainly responsible for rotation, extension and
flexion. The degeneration in facet joint cause loss of cartilage
and formation of osteophytes like bone spurs. Cartilage is
nothing but a special type tissue that connects and provides a
smooth sliding surface.
Cervical spine: The spines
of the cervical anatomy are susceptible to disorders due to
degenerative changes. The pain is associated with the neck which
later spreads to other areas such as shoulders and down the arm.
Weakness may be the symptom when a osteophyte or bone spur
causes the nerve root to compress. If these bones spur form in
front of the cervical spine then the symptom might be difficulty
in swallowing.
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Lumbar
spine: As people get aged there are certain
biochemical changes that occur in the body that leads to tissue
damage through out the body. This is usually affected in people
with an age group over forty. Due to degenerative changes the
lumbar spine may actually loose its function because most of the
body’s weight is carried by lumbar spine. The symptoms include
pain, morning stiffness etc. Sitting for longer periods,
continuous movements such as bending etc may increase the pain.
Intervertebral discs:
Intervertebral discs consist of the nucleus pulposus, anulus
fibrosus and lamellae. Nucleus pulposus is a gel like substance
which is found inside the intervertebral disc locked by the
annulus fibrosus. The annulus fibrosus consists of more than
sixty concentric bands of collagen fibres which are collectively
known as lamellae. The nucleus is formed by collagen fibres
along with water and proteoglycans. When degenerative changes
occur, the structure of these discs may be compromised. The
degenerative changes may cause the annulus fibrosus to wear and
tear. The changes may also decrease the height of the disc
leading to a condition known as the disc herniation. With ageing
the water content of the nucleus begin to decrease affecting its
ability to bounce back. |
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Diagnosis
Diagnosis is usually based on the symptoms of the individual and
their history. It is done in three separate categories such as
neurologic evaluation, physical evaluation and x-rays and other
tests. Neurologic evaluation done with care can determine the
affected nerve roots based on the symptoms like pain, numbness,
tingling etc. Physical examination may involve general tests like
the blood count, fitness test, urine analysis etc. Physical touch by
the doctors can reveal certain spinal abnormalities, muscle spasm
and areas of tenderness. Patients may be asked to do certain
movements in order to check the movement of flexion, spinal
rotation, extension and lateral bending. Tests such as x-rays are
done to locate the loss of vertebral disc height, presence of bone
spurs, stenosis, space between the vertebrae etc. However other
tests such as CT scan or MRI are performed to identify the ligament
and nerve abnormalities. Electromyogram (nerve conduction velocity)
or somatosensory may be required to confirm which nerve roots are
involved.
Treatments
Treatments depend on the age of the patient, degree of severity of
the disease. Some mild cases can resolve even without any treatment.
The treatments given for spondylosis include the following:
• Pain relief medications.
• Nonsteroid anti-inflammatory medicines (NSAIDs).
• Physiotherapy.
• Neck collar.
• Muscle relaxant medications.
• Lumbar support belt.
• Traction – only in extreme case.
• Surgery in severe case.
Pain is usually treated with NSAIDs such as aspirin or ibuprofen. If
these drugs are ineffective, then corticosteroids and muscle
relaxants are given. Once the pain is reduced exercises which
involve in strengthening the muscles of neck are prescribed. If the
pain is chronic, then certain antidepressants are prescribed.
Similarly if the pain is severe then corticosteroids combined with
anaesthetic are combined and injected into the space between the
damaged disk and the covering of the nerve and the spinal cord. If
even after this the pain is not subsided then the next option is
surgery. Surgery is generally recommended for neck pain and for
people suffering with myelopathy. There are certain alternative
treatments involved which will help in reducing the pain, strengthen
the muscles and relieve tensions.
Some of them include
• Acupuncture and chiropractic Helps in relieving pain related to
disk problems.
• Magnet therapy This includes application of high strength rare
magnets at the areas of pain. It should be applied continuously at
least for three weeks.
• Yoga Helps in strengthening the muscles.
• Alexander technique Helps in certain exercises that prevent
further symptoms.
• Homeopathy Helps in rebuilding the weakened structures.
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