Osteoarthritis In The Spine

Spotting The Early Warning Signs...

The Short Answer –

You suffer with back pain, but with a unique set of symptoms and no obvious reason why it started… Could you actually have the start of osteoarthritis in the spine?

In this article we look at the likely causes and early symptoms to help you if you think your back pain might not just be the standard strain…

Feeling Pain In Your Back?

Most back pain is, as discussed previously, purely ‘mechanical’ in nature. In other words, you’ve just strained a muscle and a simple treatment of hot and cold therapy followed by maybe a session on a TENS machine with intermittent painkillers (as and when required) will have you back to normal in no time.

However, sometimes it may actually be osteoarthritis that is causing the problem. It is important to know the difference, because the ideal treatments are different.

Furthermore, as with all forms of osteoarthritis, early diagnosis is key and how early you catch it, will have a disproportionately large impact on the future of treatments. Very advanced osteoarthritis is almost impossible to treat with any success.

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Osteoarthritis In The Spine – The Spondylosis Effect

When osteoarthritis starts to affect your spine, it will affect both the normal structure of your spine and subsequently it’s function.

This is known as ‘spondylosis’.
Spondylosis is literally just another name for osteoarthritis in the spine. It is characterised by your spinal discs starting to degenerate and your facet joints getting damaged.

If your spondylosis continues to advance, it can become what is known as ‘spinal stenosis’. This is characterised by a narrowing of spaces in the spine caused by osteophyte growth (bone spurs that grow slowly over time).

The narrowing of the spinal gaps then leads to pressure on the spinal nerves and frequently a debilitating level of back pain.

Another level of osteoarthritis in the spine occurs when it affects your facets joints to the point that one piece of your spine (vertebra) literally slips over a lower chunk of spinal bone.

This is known as degenerative spondylolisthesis and typically happens when L4 (the number of one of one of your spinal bones) slips over L5.

Potential Causes For Osteoarthritis In The Spine

The spinal cord is protect by a 3 joint complex – that is two facet joints (also known as ‘zygapophyseal joints’) and an intervertebral disc. All of these joints are potential sources of excruciating back pain.

Traditional thinking said ‘osteoarthritis is purely caused by wear and tear’. Now we know however, this is very much not the case and it’s a disease of the entire joint since many other parts of the joint can be affected before wearing takes place.

Although the exact cause is still to some extent a mystery we can narrow it down now to a number of potential causes.

Below are a number of key reasons that could cause you to develop osteoarthritis in the spine. These include –

Genes

The likelihood of inheriting spinal osteoarthritis is one of the highest of all the forms of osteoarthritis.
I wont go in to the detail behind it (it’s not really relevant here), but it’s in large due to the 143383 nucleotide polymorphism (that shouldn’t mean anything to you!).

The take away here is just to know that if your parents or grandparents had osteoarthritis in the spine, you need to be telling your doctor if you start to feel any back pain.

Age

Age is still the single largest linking determinant of osteoarthritis. Not just down to physical use (although that plays a part), it is the entire anatomy of your spine.

As you age, there are changes in stability, surrounding muscle strength, hormones, cartilage and your entire supportive matrix.

This can frequently lead to maladaptations in your joint – in other words your joints start over-compensating and alter their natural positions to ones that do not bear your weight properly.

Far from helping, this actually just makes your back pain worse and the chance of degeneration even greater.

Gender

This also has more effect on spinal osteoarthritis. In this case, women and old men are most vulnerable.

This is because body shape can dictate spinal curvature and excessive curvature as you age and your spine weakens, leads to what is known as ‘lumbar lordosis’.

This is turn has a very significant effect of the development of osteoarthritis in your spine.

Nerve Injury

Assuming you didn’t damage the bone, even just peripheral nerve damage can cause an inflammatory effect that ultimately triggers the beginning of osteoarthritis.

Furthermore, this pain can cause you to ‘adapt’ how to take on various activities, leading to an uneven pressure load on your spine and further development of spinal osteoarthritis.

Joint Injury

Similar to a nerve injury, only in the case of a physical injury to the joint, many of your supporting tissues may be damaged. This can lead to a poorly supported spine that increases the load on certain areas causing further damage.

This is in addition to the other osteoarthritis ‘starters’ of inflammation and spinal adaption to avoid injury as covered above.

Repeated Overuse

This could be seen as a slight contraction when I state that both overuse and underuse are risk factors for spinal osteoarthritis.

But it makes perfect sense – while we now know many factors play a part, osteoarthritis is still fundamentally a disease that at least involves a heavy element of wear and tear.

So the more you use your back, the more likely it is to wear down.

High impact sports are particularly risky here – since they can incur both overuse and injury to the joints in your back.

Lack Of Activity

Similarly, a lack of activity typically leads to muscle wastage around your spine and a lack of strength to support your bones.

This all leads to a greater strain on your body the next time you do take on activities such as lifting or even walking up stairs and therefore a greater risk of injury or uneven wearing.

Body Weight

Again this is of course crucial because your spine is responsible for carrying much of your body weight. 

According to Lindey et al in StatPearls,

“For every five kilograms of weight gain, there is a 36 percent increased risk for developing osteoarthritis.”

Poor Posture

Slouching in chairs or leaning over computers has all been known to put pressure on the spine. As well as various disc injuries, you also risk developing osteoarthritis in the spine.

Early Signs Of Osteoarthritis In The Spine

There are a number of symptoms that would suggest your back pain is a lot more serious than a simple muscle pull. I covered a lot of these in my article on ‘Lower Back Pain Red Flags’.

However, there are some that are very specific to osteoarthritis of the back. These include –

  • Pain in lower back or neck

  • Pain that radiates down your arm or into your shoulder

  • Morning stiffness that lasts for up to 30mins but eases with activity

  • Limited range of motion

  • Incontinence for no other obvious reason (Bowel or bladder)

  • Numbness or ‘saddle anaesthesia’

  • Pain that worsens throughout the day caused by activity

  • Weakness in one or both arms

Diagnosis

Unique to osteoarthritis in the spine, is the fact that not only is the origin of approx. 85% of back pain unknown (PLoS ONE), but radiographic images do not always match the severity of the symptoms.

This means that sometimes doctor-led diagnosis may end up offering treatment advice based on the images, that does not match the actual symptoms (The American Journal of Physical Medicine And Rehabilitation). 

None the less, the typical doctor examination when spinal osteoarthritis is suspected, will follow the simple processes…

  1. Risk Assessment Based On Family History/ Weight/ Age and Gender
  2. Physical Examination To Establish Areas Of Pain Following Light Manipulation
  3. X-Ray To Look For Joint Damage
  4. An MRI Scan If Your X-Ray Is Unsuccessful In Diagnosing Definitive Osteoarthritis

Why You Must Not Ignore The Early Signs…

NEVER, NEVER, NEVER ignore the early signs of osteoarthritis.
It is vital to know that joint or nerve injuries, age, weight and or family history could all leave you at high risk of developing osteoarthritis.

Similarly, any of the key warning signs above that accompany your back pain should warrant an immediate trip to the doctors.

Why? Because osteoarthritis has no cure and unlike knee or even hip osteoarthritis, you cant just replace your entire spine if you let it develop to the point of disability.

Instead you have to take steps to slow down the progression of your osteoarthritis and treat the painful symptoms early to maintain the highest quality of life.

The Final Word –

Every version of osteoarthritis is a crime against living the fullest life.

But this is even more true with osteoarthritis in the spine, because there are not the normal range of surgical replacements that can be done with other joints.

Furthermore, when it gets worse (spinal stenosis), it cannot simply be reversed to a time less painful.

Like climbing up a frozen hill, sometimes the best you can do is just to stop sliding down and prevent it from getting worse.

Thankfully, we have another article with full advice on how this can be achieved (slowing osteoarthritis in the spine – not sliding down a hill!)

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References Used –

1. Verhaeghe N, Schepers J, van Dun P, Annemans L. Osteopathic care for spinal complaints: A systematic literature review. PLoS ONE.
2. Ben L. Laplante DO, MS Michael J. DePalma MD. (May 2012). Spine Osteoarthritis. The American Journal of Physical Medicine And Rehabilitation
3. Thomas Lindsey; Alexander M. Dydyk. Spinal Osteoarthritis. StatPearls

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