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Arthritis of the Spine

Arthritis of the Spine

Introduction

Arthritis is derived from the Greek word “arthros” meaning a joint and its attachments, and “-itis” denoted inflammation. Hence, arthritis simply refers to a condition of the body that causes pain, stiffness and swelling in joints. There are various kinds of arthritis and fifty million Americans suffer different kinds of these arthritis. Approximately ninety percent of the people who are fifty five and older have some kind arthritis. In fact in the year 2020 it is estimated that at least sixty million people will suffer from this condition.

What is osteoarthritis?

It is the most common type of arthritis. It is derived from “Osteo” meaning bone and this kind of arthritis affects the weight-bearing joints such as the spine. The sliding joint is one of the most common joints in the body and is located in between the individual vertebrae of the spine.

Articular surfaces, a joints contact area are covered by cartilage and thick synovial fluid as lubricant. The joints move with ease with very minimal friction, but due to natural deterioration of the joint, it renders the surrounding cartilage rough and worn out. When this happens, raw joint rub against each other causing inflammation, the bone formation spurs, stiffens and causes pain. The synovial fluid can also eventually thin out which can also cause inflammation.

Due to the strain that is placed on the spinal joints such as pressure from supporting the body’s weight, it is more easily more prone to developing arthritis. It occurs in the facet joints or vertebral joints. These joints are responsible for connecting the vertebrae and is usually located at the end of the spine. They are also responsible for movements such as bending and twisting. Overtime with age, they become thick and hard which leads to osteoarthritis of the spine.

When cartilage breakdown occurs in the facet joints, then the person is usually diagnosed to have degenerative arthritis. The pain it can cause varies from minimal to severe pain, which can affect other nerves and to other parts of the body commonly the buttocks and upper thighs. Eventually, as the condition progresses it causes more frictional pain. This results to back pain and stiffness which decreases motion and flexibility.

Spinal osteoarthritis can sometimes be mistaken for DDD (degenerative disc disease). DDD is the gradual deterioration of the spine discs found in between individual vertebrae that serve as cushions and shock absorbers for movements from the spine. These two conditions usually occur together, but it is important to note that they are different conditions.

Bone spurs

Bone consistently tries to repair itself by growing more bone when it is under stress, but the new bone can have a different form and structure compared to the original one. Overtime, these bone spurs which are the irregular bone growths will build up on the facet joints and spinal vertebrae. This condition is usually caused by arthritis because of the increased friction between bones.

Causes

Osteoarthritis in the spine has several underlying causes and risk factors. The physician responsible for diagnosis will help the patient identify the specific cause of their condition. This condition is irreversible. Hence, it is important to know the different causes that can be altered through lifestyle changes in order to delay the progression of the disease.

Generally, it is caused by the gradual wearing down of the cartilage at the facet joints. These joints permit adjacent vertebrae flexing and extending. Once the cartilage wears down, it becomes still and inflamed. In this arthritic joints, bone spurs and osteophytes can develop due to the friction between the bones. This can narrow the spinal cord and nerve root exits that can lead to nerve compression. The following are possible causes of osteoarthritis in the spine:

* Aging

The deterioration of the joint cartilage increases as one grows older especially in ages 30-50.

* Gender

Women, specifically post-menopausal women are more likely to develop osteoarthritis.

* Obesity

The development of the cartilage deterioration increases as there is more weight that increases the stress on weight-bearing joints such as the facet joints.

* Disease

Certain diseases can eventually lead to osteoarthritis such as diabetes, rheumatoid arthritis and infections.

* Genetics

If a family has a history of arthritis and other joint diseases then this can potentially increase the risk of developing osteoarthritis in the spine.

* Occupation

Some occupations can cause repetitive stress on the joints dues to certain tasks that are involved with it.

* Bone Deformities

If a family has a history of defective cartilage defects, this can increase the risk of osteoarthritis.

Symptoms

The following are common symptoms from spinal osteoarthritis:

* Stiffness or spontaneous feeling of joint locks

* Pinched nerves

* Inflammation

* Localized pain or throbbing when the joint remains motionless

* Radiating pain that arises from the back and to other extremities

* Contact of bone to bone like crunching

* Numbness

* Tingling sensation

* Decreased flexibility

Risks

The cause of spinal osteoarthritis has not yet been fully determined, there are factors that increase the risk of its development. The following are examples of such:

* Repetitive bending and lifting

These repetitive motions can cause stress on the joints and cause it to eventually develop spinal osteoarthritis

* Spinal trauma or injury

A sudden force or impact to the spine that can cause stress on the joints can also cause spinal osteoarthritis.

* Obesity

Increased weight increases the stress on joints, since the spine has weight bearing joints, it can be affected then eventually develop arthritis.

* Genetics

The risk of developing this diseases is more likely of a person has a family history of this degenerative spine disease.

* Gender

Evidence shows that women are more likely to develop this condition than men.

* Poor posture

Poor posture can also increase the strain and stress on the joints.

* Smoking

* Age

The risk increases with age. The older one gets, the more they may be prone to developing osteoarthritis.

Prevention

As mentioned before, the cause of spinal arthritis has not yet been fully determined. Although research has shown evidence that genetics is the reason for the onset of this disease, there are still some steps one can take in order to prevent the risk of developing this condition. The following are examples of such:

1. Weight management

Managing one’s weight is one of the best ways to prevent unwanted stress on the facet joints. The extra pounds can increase pressure on the joints and overtime cause the cartilage to break down.

2. A balanced diet

Keeping a well-balanced diet will help manage one’s weight. Since increase in weight could potentially increase the risk of developing arthritis in the spine, a well-balanced diet will keep you from gaining unwanted pounds.

3. Low-impact exercises

Low-impact exercises can help keep the joints healthy. It strengthens the muscles that help in body weight support in order to remove some of the pressure in the weight-bearing joints in the spine.

4. Getting adequate rest

Overuse of the joints can also cause arthritis in the spine. Hence, balance is key to maintaining healthy joints. Swelled joints need to rest in order to heal. This will help delay any development of arthritis in the joints.

5. Avoid smoking and abusing alcohol

Having a healthy lifestyle is crucial to maintaining healthy joints. Smoking is bad for the bones and it releases toxins in the body that can keep the spine from receiving certain nutrients.

Treatment

Overtime the spine can develop a degenerative spine condition called spinal arthritis. Several factors can increase the risk of its development such as abnormal weight gain. This causes excruciating symptoms such as pain, numbness and stiffness. Through the help of a physician, there are several treatments that are available to a person who has developed arthritis in the spine and is suffering from certain symptoms.

Often the first step to treatment is to remove unwanted pressure on the joints, and increase strength and flexibility. However, this condition could also lead to other painful results such as

bone spurs and pinched nerves. Hence, treatment can possibly include medications and injections. Treatment can be classified to into two: conservative and surgical treatment.

Conservative Treatment

Not all spinal arthritis will immediately lead to surgery. Often mild cases of arthritis can easily be healed through conservative treatments. There are several conservative treatment options and a combination of these treatments is also possible depending on the patient’s circumstance.

* Physical Therapy

Physical therapy focuses on relieving the joints of the spine from unwanted tension and strain. It involves certain exercises in order to provide better circulation in the affected area. It also focuses on strengthening core muscles to better distribute weight support in the body thereby, decreasing the load in those weight bearing joints. The sessions may also include lessons on proper lifting techniques and other proper body mechanics.

* Exercise

This will help increase the spine’s mobility and flexibility. It is important to do low-impact exercises such as walking and light stretching.

* Medication

Usually, over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen is suggested to reduce inflammation, pain and other excruciating symptoms. This can however be harsh on the stomach. If a patient cannottake NSAIDs, then another over-the-counter medicine is prescribed – acetaminophen. Unlike the NSAIDs, it won’t treat the inflamed part, but it will help lessen the pain from the arthritis. This however, will not be good for those who have liver problems and will have to be monitored for its intake.

* Exercises

Spinal arthritis exercises will increase mobility and flexibility. Exercises such as swimming, walking and biking are example of low-impact exercises that can help the body remain active and healthy.

* Rest

Sometimes, adequate rest is enough to reduce the pain and inflammation from the affected joint.

* Injections

In some cases, the physician may advise the use of corticosteroid injections. These are directly administered in the affected joints. This will reduce pain and inflammation and increase lost mobility. However, repeated injections are not advised since it can also damage the joints. Treatments then are mostly limited to a few times per year.

Alternative Treatment

Conservative treatments are conventional ways of treating the arthritic joint. However, there are also several alternative treatments that are considered together with a conservative treatment. There remains plenty of speculation around these treatments that do not fall on mainstream medicine paths. It is important to work closely with a physician to ensure that treatment from a licensed professional or a renowned practitioner.

* Acupuncture

Acupuncture is an eastern medicine that utilizes thin needles to be inserted at specific points in the body. It has some evidence to provide relief from certain conditions including arthritis in the spine.

* Chiropratic

This is a manipulative treatment for the spine for misaligned parts, benefitting mostly those with low-back pain. Hands-on therapy and spinal adjustment is the core of chiropratic care. It too has some evidence to provide relief from excruciating symptoms of spinal arthritis. However, there have been some reports on fatal side effects such as stroke specifically those done in the neck.

* Herbal medicines

Herbal medicines come from plant-based remedies such as flax, turmeric and ginger that has some evidenced to provide relief from painful symptoms caused by spinal arthritis.

Surgical Treatment

Open spine surgery

This is the traditional kind of surgery. There are two types of surgery that can be conducted through this. The first one is decompression. This means that in order to relieve excruciating a decompression procedure is conducted through removal of a bone tissue, part of a disc, or other part of the spinal anatomy. This will help alleviate the pressure causing nerve compression.

The second kind is the spinal fusion where a bone graft or other material is inserted in order to provide support and stability in the spine, in which two or more vertebrae to grow together.

Since it is the traditional surgery, more surgeons have more experience in conducting this surgery. However, there are also several cons to this surgery. It requires a large incision in the back or other parts in order to reach the affected area. The loss of blood, risk of infection and muscular disruption is much higher. It also requires a longer recovery period, which can potentially be more difficult.

Minimally invasive surgery

As the name implies, this surgery requires more minimal incisions. Through which a series of dilating tubes are introduced in order to insert visualization technology and micro-instruments in order to perform the removal of bone or tissue in the affected are that the cause for the symptoms. After this procedure is done, the tubes are removed and the incisions are closed. Unlike the traditional open spine surgery, this can be done as an outpatient surgery. It also offers a shorter recover period, less chances for infection and loss of blood. However, this may not be favourable if there are multiple procedures to be performed in the spine.

Recovery

During recovery period after surgery, the physician will be providing the patient specific instructions. It is essential to follow the physician’s orders to the letter. While a traditional open spine surgery might take more time to heal compared to a minimally invasive surgery, the recovery period can differ per patient. The progress may vary due to many factors. However, there are general guidelines that must be followed during the initial recovery period.

It is important to avoid applying force to the spine by limiting weight lifting activities. Continue to shift positions from time to time. It is important not to remain stagnant for more than ten to twenty

minutes. Avoid driving unless you are off the medications for pain and relaxants. Watch the dressing such that it doesn’t get wet. In case bowel movement is not experienced since the last forty-eight hours, then it is important to contact the physician.

In most cases, the patient is eventually assigned sometime in the recovery period to begin certain exercises to help the spine to fully recover. However, it again is important to follow the physician’s instructions to the letter and remember not to overdo these exercises.

Depending on the surgery that was conducted, the exercises may vary. Each part of the spine that was affected will have different exercises. If a cervical procedure was conducted then exercises may include the following:

* diaphragmatic breathing
* abdominal bracing
* cervical mobility flexion and extension
* cervical rotation and shoulder shrugs.
If a lumbar procedure was conducted then the following exercises may be introduced:
* diaphragmatic breathing
* abdominal bracing
* shoulder presses
* gluteal seats
Exercises that are more intensive in nature may also eventually be introduced

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