The degenerative process of spondylosis can affect the cervical (neck), the back or the lumbar region (lower back) of the spine .

The terms used to identify the disease vary by location:

  • At the level of the neck is called cervical spondylosis
  • At the level of the back is called lumbar spondylosis
  • At the dorsal level it is called thoracic spondylosis.

The term spondylosis is not only used to describe arthrosis of the spine, but is also used to describe any type of degeneration of the spine.

 


Anatomical changes

With age, biochemical changes occur in all tissues of the body.

In the column, the structure of the intervertebral discs (fibrous ring, lamellae, nucleus pulposus) is ruined.
The fibrous ring (the outer part) is composed of about 60 concentric circles called lamellae composed of collagen fibers.
The pulp nucleus is a gelatinous substance within the intervertebral disc surrounded by the fibrous ring. The core is composed of collagen fibers, proteoglycans and water.
The degenerative effects of aging may weaken the fibrous ring structure, causing usury consumption and repeated lacerations.
The water content of the nucleus decreases with age, resulting in the gradual loss of the ability to absorb the traumas and the microtraumas of the day to day (damper). Structural changes in degeneration cause a decrease in disc height and increase the risk of disc herniation.

 

The articular facets (called zigoapophyseal joints ). Each body of the spine has four articular facets that function as a hinge or pivot. These are the joints on which the joint movement of the spine occurs and allows for extension, flexion and rotation.
Like the other joints, the joint surfaces of the bone are covered by cartilage.
Cartilage is a special type of connective tissue that lubricates and reduces friction on slip surfaces.
Osteoarthritis of the facet joints involves the loss of cartilage and the formation of osteophytes (bony spurs). These changes can cause hypertrophy of the joints and spondylosis, also known as degenerative joint disease.

Osteophytes (bony spurs) may form around the perimeter of the vertebral plate (the upper body of the vertebra). These exostoses (bony protrusions) may compromise the blood supply to the vertebra. In addition, the phenomenon of bone sclerosis occurs, i.e. a thickening or hardening of the bone under the joint surface.
Ligaments are bands of fibrous tissue that attach to the structures of the spine (for example, the vertebrae) and protect against excessive movement (for example, hyperextension).

However, degenerative changes can cause loss of ligament strength.
The yellow ligament (a primary spinal ligament) can thicken and make a posterior (back) obstacle to the dura (the spinal cord membrane).

Causes and risk factors for spinal arthrosis

There are several reasons for which some people are particularly prone to osteoarthritis. However, as with almost all diseases that affect body deformation, it is likely that arthrosis is caused by a combination of risk factors that occur together.

Repetitive spinal injuries such as stretching or compression caused by road accidents , surgical intervention, sports injuries, poor posture, or work-related activities can cause spinal arthrosis.
Therefore, athletes and people who carry out repetitive and especially heavy movements are those who are most at risk.

 

Other risk factors for the development of vertebral arthrosis are:

  • The regular and advanced aging of spinal structures from the age of 30, often related to work.
  • Typically, arthrosis is more common in postmenopausal women , but before the age of 45, it is more common in men.
  • Overweight: Obesity causes more stress on the supporting joints and on the spine, especially for middle-aged people.
  • Genetics: those with a family history of arthrosis, congenital defects of the joints, poor alignment of the spine or lower limbs, easily develop spondylosis:

When a specific cause of arthrosis is unknown, as it is in most cases, it is called primary arthrosis, it seems to be caused primarily by aging.
Age leads to changes in cartilage and synovial fluid, increases water content in tissues and decreases protein content.

 


Signs and symptoms of arthrosis in the spine

Many people with visible spondylosis on radiography have no symptoms.
In fact, lumbar spondylosis (arthrosis of the lower back) is present in 27-37% of people without symptoms.
Spondylosis can cause back pain and pain in the neck and in some people due to compression of a nerve (root irritation).
Nerve compression is caused by bony spurs or bony protrusions on the articular facets that cause the nerve roots to narrow ( foraminal stenosis ).

Although not large enough to pinch a nerve, the bulging of the disc can cause local inflammation and irritation of the nerves of the spine.
In addition, a herniated disc can press on the ligaments of the spine and cause pain.
Because of the pain, the area of ​​the spine can try to block itself, with consequent local stiffness, muscle spasm and activation of trigger points.
However, there are conflicting opinions about the possibility that mild spondylosis, small spurs and bulgingdiscs that do not pinch nerves can cause back pain. Most middle-aged and elderly people have signs of spondylosis on the radiograph but do not feel pain. So there are other factors that are likely to cause back pain.
The symptoms of spondylosis are pain located in the area where there are signs of arthrosis, usually in the lumbar or cervical spine.
If a herniated disc causes a nerve crush, the pain may radiate to a limb.
For example, a herniated disc in the lumbar spine of the large lumbar spine can cause compression of the sciatic nerve and cause pain that originates in the lower back and continues along the leg to the feet. 
This disorder is called sciatica or sciatica. Back pain caused by a disc protrusion the bulging worsens while maintaining a prolonged standing position, sitting and leaning forward, while improving frequently changing position and walking.

Back pain caused by osteoarthritis of the facet joints causes pain in the feet and walking, while relieving sitting, lying down and when leaning forward.

The symptoms of numbness and tingling can be felt if a nerve is compressed. If the nerve is severely irritated, the affected limb may become weaker and less sensitive.
If a herniated disc pushes over the spinal cord, it may interfere with the functioning of the nerve (myelopathy).
The symptoms of myelopathy are: numbness, tingling and weakness. For example, a large herniated disc in the cervical vertebral column if it is large enough to push over the spinal cord can cause numbness, tingling, and weakness in the arms and even the legs .

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