SPONDYLOSIS- CERVICAL & LUMBAR

BY
PROF. DR HARIPRASAD S
 • Introduction
SPECIFIC • Aetiology
LEARNING • Pathophysiology
OBJECTIVE • Cervical spondylosis – clinical features &
management.
• Lumbar spondylosis – clinical features &
management.
 INTRODUCTION
Spondylosis (spinal osteoarthritis) is a degenerative disorder.

It is the general wear and tear that occurs in the joints and bones
of the spine as people get older.
• More than 85% of people over age 60 are affected.

Spondylosis may affect the cervical (neck), thoracic (mid-back), or

lumbar (low back) regions of the spine.
• It may cause loss of normal spinal shape and function.
• Although ageing is the primary cause, the location and rate of change differ from
person to person.
•Degeneration of cervical/lumbar

IVD and the secondary

degeneration of cervical/lumbar

Intervertebral joints leads to injury

of the spinal cord, nerve roots and

vertebral artery, and shows

corresponding symptoms and

signs.
 AREAS AFFECTED

Cervical The complex anatomy and large movements in the neck

make this area of the body susceptible to degenerative change.
(neck)
Neck pain from spondylosis is common. The pain may spread into
the shoulder or down the arm.

Thoracic The thoracic spine is less commonly affected due to its reduced
movement.
(mid-
back) If there is spondylosis in this region, the shape of the mid back can
round to the appearance of a hunch back, this is called a kyphosis.
 Lumbar (low back)

• Spondylosis often affects the lumbar spine in people over the age of 40.
• Pain and morning stiffness are common complaints.
• The lumbar spine carries most of the body's weight.
• Therefore, when degenerative changes affect its structure, you may get
pain with activities such as walking, standing, lifting objects or after long
periods of rest or sitting.
 CAUSES OF SPONDYLOSIS
Aging: when we get older, the discs dehydrate, become thinner and become harder. They
provide less support to the vertebrae resting on the discs.

Repetitive strain injury (RSI) caused due to lifestyle without ergonomic care, e.g., while working
in front of computers, driving, traveling, intense work in farm, etc.

Obesity: Overweight puts excess load on the joints as the lumbar region carries most of the
body’s weight, making a person prone to lumbar spondylosis.

Risk factors: Genetics – if family has a history.

• Occupation: jobs with lots of neck motion and overhead work, pursuing

White collar jobs or keeping the neck constantly in one position while reading,

writing etc.

• Mental health issues: depression/anxiety

• Injuries/trauma: car wreck (RTA) or on-the-job injury

• Smoking: linked to increased neck pain/ back pain

 PATHOPHYSIOLOGY

Cervical/lumbar spondylosis is the degeneration of the

intervertebral disk. When we get older the disk, fragments, loses
water content and collapses.

This starts in the nucleus pulposes (the inner part of the IVD), the
water content will decrease and will start buckling inward, and
the annulus fibrosis (the outer part of the IVD) will become
thinner and bulge outward.
When the IVD becomes thinner it
will increase the mechanical
stress at the cartilaginous end
plates at the vertebral body lip.
The cartilage that covers and
protects the joints wears away.
If the cartilage wears away
completely, it can result in bone
To make up for the lost cartilage, our body may
respond by growing new bone in your facet joints to
help support the vertebrae.

Over time, this bone overgrowth called spurs may

narrow the space for the nerves to pass through
(stenosis).

In addition, hypertrophy of the uncinate process

(cervical) occurs, often encroaching on the
ventrolateral portion of the intervertebral foramina.
It can "pinch" or compress those nerves.
 CLINICAL FEATURES OF CERVICAL SPONDYLOSIS

Pain from cervical spondylosis can be mild to severe.

Neck pain and stiffness (may be worse with activity).

Neck pain: radiating to the ipsilateral upper extremity paresthesia

Muscle weakness in the appropriate distribution.

Pain and paresthesia may be intensified by neck movement.

• Signs
–Stiffness of neck
–Tenderness, spasm of paraspinal muscles
–Limitation of active and passive motion of the neck
and affected upper extremity.
Radiographic study

Demonstrate
osteophyte
formation and
narrowing of
intervertebral
foramen.

 CT
scan
 Cervical spondylotic myelopathy (CSM)

Midline herniation of nucleus pulposus

Osteophyte of posterior rims of vertebral body

Hyperplasia of the ligamentum flavum

Calcification of the posterior longitudinal ligament

Lead to compression of the spinal cord

 Clinical manifestation
• Symptoms
– Numbness
– Weakness
– Dysfunction of upper motor
– Loss of balance neuron is gradually present
– Cannot handling from the lower part of body
small objects to the upper.
– Neck pain not – Spastic paraplegia or
obvious quadriplegia
– loss of control of
the bladder or
bowels
 Signs
• Marked motor changes • Pyramidal tract sign
and relatively few
– Hoffman’s sign or reflex
sensory changes.
– Babinski’s sign
– Hypertonic (high
muscular – Obstacle of fine motion of
tone) the fingers Such as
– hyperreflexia buttons, write
– Patellar clonus +
– Ankle clonus +
Calcification of the posterior
longitudinal ligament
MRI
 Vertebral artery type of CS

• Pathology
• Hyperplasia, stenosis of cervical vertebral
transverse foramen, hypertrophy of
upper articular process, unstable cervical vertebra
• Directly stimulate,
compress vertebral artery
• Symptoms
–Vertigo is mainly, induced by rotating neck
–Migraine
–Sudden blackout, Diplopia, recovered in short time

–Cataplexy caused by a sudden spasm of artery

due to stimulation, coming at once (falling to the
ground).
• Sign

–Positive neck rotation test

Treatment
• The goal of treatment is relief of pain and prevention of permanent spinal

cord and nerve root injury.

• In mild cases, no treatment is required.

• Symptoms from cervical spondylosis usually stabilize or regress with simple,

conservative therapy including a neck brace and NSAIDs.

 Nonoperative treatment
• Halter traction
• Cervical support and collar
• Physical therapy
• Analgesics and muscle relaxants
• Local block
Halter traction
• Heat Therapy- Improves blood circulation, decreases nerve and

muscle inflammation and relieves muscle spasms.

• Cold Therapy- Decreases inflammation, relieves muscle spasms and

reduces nerve irritation by reducing nerve oedema.

• TENS - Can be issued to a patient for home use. Stimulates the muscles through

variable intensities of electrical current. It helps reduce muscle spasms and pain. It

may also drive out inflammation, bring in healing properties, relax, and re-educate the

muscles involved.

• SWD - Relieves muscle spasms and causes muscle relaxation, reduces inflammation and

improves blood circulation.

 Deep Tissue Massage:

• This technique targets spasms and chronic muscle tension that

perhaps builds up through daily life stress. You could also have

spasms or muscle tension because of strains or sprains.

• The therapist uses direct pressure and friction to try to release

the tension in your soft tissues (ligaments, tendons, muscles).

For every inch your head
moves forwards, it gains 10
pounds in weight.
Correct Bad Posture
Pillow height
Sleeping
 Manual
•therapy : mobilization and manipulation, may provide further
Such as
relief for patients with cervical spondylosis.
• Mobilization is characterized by the application of
gentle pressure within or at the limits of normal motion,
to increase the ROM.
• The intention is to increase articular mobility or to
realign the spine.
 Operative treatment

Anterior cervical decompression and fusion ( ACDF)

Artificial disc replacement (ADR)

Laminectomy

Laminoplasty
 SURGICAL MANAGEMENT
• Laminectomy: is a procedure to remove the bony
arches of the spinal canal decreasing pressure on
the spinal cord.
• Discectomy: is a procedure to remove a portion
of
an intervertebral disc that is putting pressure
on a nerve root or the spinal canal.
• Foraminectomy: is a procedure to expand the
openings for the nerve roots to exit the
spinal canal.
• Fusion: fusion of the vertebrae is sometimes
combined with one or more of these
procedures in order to stabilize the spine.
 Lumbar Spondylosis

• Lumber Spondylosis is a term referring to degenerative osteoarthritis of

the joints between the centre of the lumbar vertebrae and/or neural
foramina, that leads to the narrowing of space between two adjacent
vertebrae & compression of a nerve root emerging from the spinal cord
may result in radiculopathy – sensory or motor disturbance.
The Lumbar spine carries most of the weight of the body

therefore; lumbar Spondylosis affects activities Such as walking,

standing, and lifting objects after long period

Causes:

• Aging: The disc dehydrates, becomes thinner and becomes

harder

• Repetitive strain injury (RSI): caused by a lifestyle without

ergonomic care. e.g while walking, sitting in front of the

Symptoms:

• Many people do not have any

symptoms(27%-37%)
• Spinal stiffness, particularly early morning
• Back pain due to nerve compression
• Regional tenderness
• Muscle spasm
• Trigger points
• Sciatica
• Numbness
• Weakness
 • Swelling/ external deformity noted
• Spinal tenderness
• Passive SLRT

Local •
•
PSMS
PATRICK TEST
examination • SST
•
of LS Spine
Power
• L2 hip flexion
• L3 knee extension
• L4 ankle dorse flexion
• L5 great toe extension
• S1 ankle plantar flexion
• Active ankle and toe movement ------bilaterally.
• Peripheral pulsation is ------- bilaterally.
• Distal sensation ----- bilaterally.
• Reflexes
• NO DNVD
 DIAGNOSIS
• X-ray: These pictures are traditionally ordered as a first step in imaging the
spine. X-rays will show ageing changes, like loss of disk height or bone
spurs.
• Magnetic resonance imaging (MRI): This study can create better images of
soft tissues, such as muscles, disks, nerves, and the spinal cord.
• Computed tomography (CT) scans: This specialized x-ray study allows
careful evaluation of the bone and spinal canal.
MANAGEMENT
 Lumbar Traction
• Lumbar traction (with light force only) applies a

longitudinal force to the axial spine;

Non -
Operative • The forces that open intervertebral space and

decrease spine lordosis relieve pain as traction

eliminates the stress on nerves in neural

foramina.
 • Can be beneficial for patients suffering
from chronic LBP.
Lumbar back
• It occurs to limit spine motion, stabilize,
support
correct deformity and reduce mechanical
forces.
 SURGICAL MANAGEMENT

Laminectomy: is a procedure to remove the bony arches of the spinal canal

decreasing pressure on the spinal cord.

Discectomy: is a procedure to remove a portion of an intervertebral disc that is

putting pressure on a nerve root or the spinal canal.

Foraminectomy: is a procedure to expand the openings for the nerve roots to

exit the spinal canal.

Fusion: fusion of the vertebrae is sometimes combined with one or more of

these procedures to stabilize the spine.
QUESTIONS
 QUESTION 1

The term "spondylosis" refers to

a) Inflammatory joint disease

b) Osteoarthritis of the spine

c) Bone cancer

d) Herniated disc
 QUESTION 1

The term "spondylosis" refers to

a) Inflammatory joint disease

b) Osteoarthritis of the spine

c) Bone cancer

d) Herniated disc
 QUESTION 2

Common non-surgical treatments for lumbar spondylosis include:

a) NSAIDs and physical therapy

b) Antibiotics and antivirals

c) Chemotherapy and radiation

d) Antidepressants and antipsychotics

 QUESTION 2

Common non-surgical treatments for lumbar spondylosis include:

a) NSAIDs and physical therapy

b) Antibiotics and antivirals

c) Chemotherapy and radiation

d) Antidepressants and antipsychotics

 QUESTION 3

A patient with lumbar spondylosis might experience radiculopathy due to:

a) Muscle strain

b) Nerve root compression

c) Skin infection

d) Blood clot in the leg

 QUESTION 3

A patient with lumbar spondylosis might experience radiculopathy due to:

a) Muscle strain

b) Nerve root compression

c) Skin infection

d) Blood clot in the leg

 QUESTION 4

The primary cause of lumbar spondylosis is

a) Infection

b) Autoimmune disease

c) Degenerative changes

d) Nutritional deficiency
 QUESTION 4

The primary cause of lumbar spondylosis is

a) Infection

b) Autoimmune disease

c) Degenerative changes

d) Nutritional deficiency
 QUESTION 5

Risk factors for developing spondylosis include all of the following EXCEPT:

a) Obesity

b) Smoking

c) Physical inactivity

d) High calcium intake

 QUESTION 5

Risk factors for developing spondylosis include all of the following EXCEPT:

a) Obesity

b) Smoking

c) Physical inactivity

d) High calcium intake

 QUESTION 6

The degenerative changes in spondylosis primarily involve

a) Muscles

b) Ligaments

c) Intervertebral discs and vertebral bodies

d) Skin
 QUESTION 6

The degenerative changes in spondylosis primarily involve

a) Muscles

b) Ligaments

c) Intervertebral discs and vertebral bodies

d) Skin
 QUESTION 7

A common complication of cervical spondylosis is:

a) Sciatica

b) Myelopathy

c) Osteoporosis

d) Carpal tunnel syndrome

 QUESTION 7

A common complication of cervical spondylosis is:

a) Sciatica

b) Myelopathy

c) Osteoporosis

d) Carpal tunnel syndrome

 QUESTION 8

Which of the following is a common symptom of cervical spondylosis?

a) Lower back pain

b) Neck pain and stiffness

c) Hip pain

d) Knee pain
 QUESTION 8

Which of the following is a common symptom of cervical spondylosis?

a) Lower back pain

b) Neck pain and stiffness

c) Hip pain

d) Knee pain
THANK YOU