Treatment of spondyloarthritis


Diagnosis of spondyloarthritis (arthrosis of the spine)

Anyone who experiences pain and a feeling of stiffness in their spine for more than two weeks should see a doctor.

The doctor will first inquire about the current symptoms, analyze the medical history and perform a physical examination; they may also prescribe an x-ray of the spine .

Other tests (blood work, magnetic resonance , or CT) may be done to confirm osteoarthritis of the spine or to rule out other conditions, such as tumors, infections, fractures , and other forms of arthritis .


Medical history: The patient should describe his symptoms as precisely as possible, i.e. an exact description of the pain, stiffness, joint functions, when and how the symptoms appeared and how they have developed over time.
The doctor will inquire about the patient ‘s other medical conditions and information about current medications, results of any previous treatments, family history, and general lifestyle habits (e.g., alcohol consumption, smoking, etc.).

Physical Examination: The doctor must perform a physical examination to assess the general health of the patient, including the condition of the muscles and bones, neural pathways, reflexes, and back joints.

He needs to assess muscle strength and flexibility and know if the patient is able to perform activities of daily living, such as walking, bending, and getting up after sitting.
It may be useful to have the patient perform a variety of exercises to assess range of motion and to determine if pain increases with movement.

Imaging procedures

X-ray: The doctor may order an X-ray to determine if there is joint damage and how far it has spread. The X-ray shows a decrease in the cartilage, bone changes and the exact position of any bone outgrowths (osteophytes). X-rays can also be helpful in ruling out other causes of pain and in evaluating the various options for surgical intervention.

The following additional examination procedures may be necessary to rule out other causes of pain or to demonstrate the presence of spinal arthrosis with greater accuracy than an X-ray:

  • Bone scintigraphy can rule out inflammation, tumors, infections, and minor fractures.
  • Computed tomography (CT) is used to better evaluate the width of the spinal canal and the surrounding structures.
  • Magnetic resonance imaging (MRI) provides very detailed images of the spinal cord, nerve roots, intervertebral discs, ligaments and surrounding tissue.

Treatment of spondylosis

There is no curative therapy for the degenerative changes in the spine caused by spondyloarthritis. Nevertheless, the symptoms and risk of complications can be reduced to a minimum if the disease is detected early.
The most effective therapies use a variety of approaches: physical therapy, exercise, medication and, in some cases, surgery.
In many cases, spondylosis can be successfully treated without the need for surgery.

Drug treatment of spondylosis

No drug has been able to reverse the degenerative process of spinal arthrosis. Spondylosis pain therapy includes anti-inflammatory drugs , painkillers (analgesics) and muscle relaxants.

As anti-inflammatory agents, the nonsteroidal anti-inflammatory drugs (NSAIDs) have a great effect in relieving the neck pain caused by spondylosis; these include ibuprofen and naproxen (Aleve), which do not require a prescription.
Muscle relaxants (eg Sirdalud) are medicines used to relieve muscle spasms caused by spondylosis. Painkillers (analgesics), such as acetaminophen (Ben-u-ron) and tramadol, are used to relieve pain.
If the pain is severe, a narcotic prescribed by the doctor can be taken for a short time.

There are some antidepressants that have benefits in the management of chronic back pain. Low-dose tricyclic antidepressants have been used to relieve chronic pain in the lower back, neck, and other areas of the body.

Injections and minimally invasive measures for spondylosis

Cortisone can be injected into the epidural space, which is the space surrounding the spinal cord. This process is called epidural infiltration.

Steroids can be injected into the facet joints connecting the vertebrae, into soft tissue trigger points, or directly into a disc. These measures play an important role in the treatment of acute pain, especially when it is radicular pain, ie pain that radiates into a limb.

Other measures to treat back and neck pain:

  • intradiscal injections (cortisone injections directly into the intervertebral disc),
  • Injections with cortisone , anesthetic or both combined in the trigger points,
  • steroid infiltrations in the facet joints,
  • epidural infiltrations ,
  • Steroid infiltrations into the pear muscle (piriformis) in piriformis syndrome and radiofrequency denervation (destruction of the painful nerves using a radiofrequency current).

Self-treatment for spondylosis

Self-help is very important with spondylosis symptoms, because the pain can decrease significantly or disappear completely within a few days.
Experts have found that bed rest significantly increases recovery times.
Therefore, normal activities should, at least for the most part, continue; however, all symptom-aggravating activities should be avoided, such as B. lifting heavy objects.
Some patients find relief from heat or cold applications to treat back and neck pain caused by spondylosis .
When sleeping, a pillow between your legs can relieve back pain. Special pillows offer additional neck support and have been specially developed for neck pain.

Physiotherapy, exercise and other therapies for spondylosis

The doctor can prescribe physiotherapy treatment for back and neck pain that lasts for several weeks, which is often the case with chronic conditions; physical therapy includes strengthening and stretching exercises.
Physiotherapists can teach patients specific exercises that, when practiced daily, strengthen the back and abdominal muscles. This is a good way to prevent relapses.
A regular exercise program, especially yoga, has been shown to help with chronic back pain.

Spinal manipulation performed by the chiropractor can bring relief to some patients, especially in the first month after the onset of pain. However, for safety reasons, not everyone can expose themselves to spinal manipulation.

Acupuncture for back pain involves inserting tiny needles at different depths into specific points on the body.
Studies on the effectiveness of acupuncture for back and neck pain show conflicting results.

Checks for spinal arthrosis

The doctor can schedule follow-up appointments to monitor how the patient is responding to treatment. Routine examinations such as X-rays, CT and magnetic resonance are of little use in this context.

They may be useful if the symptoms change and another therapy may be necessary, such as when sciatica or cervicobrachialgia occurs that did not exist before.

Complications of spinal arthrosis

The main complication of spondylosis is back pain, dorsalgia or neck pain. The resulting back and neck pain is not usually severe, but can sometimes become chronic.
It is rather uncommon for spondylosis to cause serious neurological dysfunction because a nerve is pinched.
Over time, the degenerative changes of spondylosis can result in spinal stenosis, which is a narrowing of the spinal canal that may put pressure on the spinal cord.

Spinal stenosis in the neck or back area can arise as a complication of spondylarthrosis.

In cauda equina syndrome, the nerves in the lower spinal cord are pinched by a mass or disc; it is a rare complication of spondylosis and can result in serious neurological disorders.

Prognosis for spinal arthrosis

In most cases, the prospects are good for cervical and lumbar spondylosis.

Often spondylosis patients do not feel the slightest symptoms.
Most people respond well to treatment within a few weeks. However, symptoms may reappear later.
Chronic long-term pain in the neck develops in one in ten cases.

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