Are you confused with the three conditions that affect the lumbar spine?
Many patients are confused about the similarity of the terms spondylosis, spondylolysis and spondylolisthesis. When examining spinal disorders, all need to get the correct information about the disease you are suffering from. In this article, Dr Surya Prakash Rao spine surgeon explains the difference between “spondylosis” and “spondylolysis” and “spondylolisthesis.” So that patients can understand to examine for the right medical conditions to take proactive steps to find treatment solutions.
So let go, through this blog to know about what is the difference between spondylosis, Spondylitis, spondylolysis and spondylolisthesis
Spondylosis: (Vertebral Arthritis)
This condition is a degenerative deformity of the spine caused by age-related wear and tear. It is associated with bone and tissue of the spine. More than 85% of people over 60 are affected by spondylosis. Almost everybody will develop these ageing changes as they grow older. The degenerative process (wear) of spondylosis can involve and affect the cervix, thoracic, lumbar spine.
Degenerative osteoarthritis of the joints between the vertebral body and foramina neurons. The space between two adjacent vertebrae narrows, resulting in compression of nerve roots. Radiculopathy causes pain, sensory and motor changes. In the cervical spine, compression of the spinal cord by arthritis can lead to myelopathy.
Bones, discs, cartilage and ligaments change as we grow. Bone spurs may develop, discs may dehydrate and get crack, cartilage may wear out, and stiff ligaments. These age-related degenerative changes are all forms of spondylosis.
Causes and Risk Factors which accelerate spondylosis
- Age: As we get older, the intervertebral discs between the vertebrae become thinner and stiffer. They then offer less support for vertebrae resting on discs.
- RSI (Repetitive Strain Injury): This is caused, for example, by an ergonomic lifestyle, working at a computer, driving a car, travelling, working on a farm, etc.
- Occupation: if work involves many neck movements
- Genetics: If the family has had neck pain in the past
- Smoking: Associated significantly with increased neck pain
Symptoms of Spondylosis:
Spondylosis does not always cause symptoms. When symptoms appear, they usually include neck or back pain or stiffness. Spondylosis can cause spinal stenosis, which is a narrowing of the spinal canal. As a result, the spinal cord roots can be pressed (pinched).
- Tingling and numbness in hands, arms, legs
- Muscle weakness in arms, shoulders, legs, neck and causes coordination problem
- Tingling and weakness in the affected area.
- Lumbar spondylosis has low back pain and can sometimes affect the foot.
- Loss of balance and difficulty walking
- Muscle spasms in neck and shoulder
- Medical management
- Muscle relaxants
- NSAIDs (Nonsteroidal anti-inflammatory drugs)
- Physical therapy management
- Heat therapy
- Cold therapy
- Electrical stimulation
- Deep Tissue manipulation
- Environmental changes
Sometimes along with the changes of spondylosis, small complications happen which can lead to compression of the spinal cord or spinal nerve roots, and the patient feels pain or nerve weakness for which surgery may be needed. The type of surgery required depends on the cause of compression of the spinal cord. Dr Surya Prakash Spinal Surgeon is well experienced and qualified to determine the best treatment for each patient and every situation.
- Discectomy: used to remove the herniated disc
- Laminectomy: To remove bone spurs or to remove parts of the spine called the lamina
- Laminoplasty: To open some space for nerve tissue by changing the position of the lamina
Spinal fusion: Spinal fusing segments with transplanted bone with or without instruments (such as rods and screws)
This is actually a condition in which the spine is inflamed. This actually is shown by the suffix –itis.
Unfortunately, a lot of patients and clinicians confuse spondylosis with spondylitis. The latter is seen in conditions like infections Like Tuberculosis and pyogenic bacteria etc or diseases like spondyloarthropathies like ankylosing spondylitis or Rheumatoid arthritis.
More about these conditions in a blog post coming soon.
Spondylolysis (pars interarticularis Defect) Stress Fracture:
The above three terms are used synonymously, and all refer to the same conditions. This condition is a stress fracture caused in a segment called pars interarticularis in the lumbar vertebra. pars Interarticularis is thin segments of bone that connect two portions of the vertebral bone. It is the area most likely to be affected by recurring stress. This condition is widespread and occurs once in every 20 people.
Causes and Risk Factors For Spondylolysis
Spondylolysis exact cause unknown, but certain risk factors have been identified. The natural inner curvature of the lower back puts stress on the interarticularis pars. Certain sports where excessive or repeated bends can increase the risk of spondylolysis. Examples are gymnastics, soccer and football. Occasionally, young athletes develop spondylolysis as a result of overuse and lower back hyperextension. Genetics can also be a risk factor for some people
What are the symptoms of spondylolysis?
Spondylolysis does not always show symptoms. If this is the case, back pain is usually the only symptom. Pain gets exacerbated by activity and exercise and is more visible when leaning back. In general, pain does not interfere with daily activities. If this continues, I recommend that you visit a doctor.
Spondylolysis treatment focuses on treating pain and helping you get back to your daily activities. There is usually no risk of spinal cord injury or nerve damage in this condition. Depending on the level of pain, treatment options include:
- Rest/break from sports
- Nonsteroidal anti-inflammatory drugs
- Physical therapy for muscle strengthening and general conditioning
- A lumbar brace
Surgery to this condition is rarely needed because in most cases, pain reduction is expected to occur over time.
Surgery for Spondylolysis:
In adolescents with lumbar spondylolysis, surgery can sometimes be an option. Doctors repair broken bones with strong titanium screws. This surgery is performed by making an incision 2 to 3 inches in the middle of the lower back. Screws are used to hold the two sides of the fracture together and provide compression throughout the area. Then, a bone graft (a piece of bone in another part of the body) can be used to help further repair.
The operation can last up to three hours, followed by two or three days to recover from the hospital. Sports and strenuous exercise are restricted three months after surgery. This operation has been very successful in relieving back pain associated with spondylolysis. Most people can return to work without pain as before.
Sometimes doctors can also recommend surgical procedures such as spinal fusion if it discovers that a spine has slipped forward due to spondylolysis. This slip referred to as spondylolisthesis, which is different but related to this disease. About that condition, you can find out more below
Spondylolisthesis (vertebral Slippage)
It is a spinal cord condition that occurs when the vertebra slips forward to the underlying vertebra. It causes progressive deformation of the lower back and narrowing of the spinal canal. It is often associated with pain.
Spondylolisthesis is a painful condition in the spine that, however, can be treated in many cases. Both conservative methods (treatment, physiotherapy) and surgery. Proper exercise can help you avoid this condition.
Causes of Spondylolisthesis:
Spondylolisthesis in children usually occurs in between the 5th bone lumbar vertebra and the 1st bone sacrum (pelvis). It is often due to congenital or developmental anomaly at birth. Some time in adults spondylolysis can lead to slip of one bone over the other which can cause spondylolisthesis. In elderly degenerative changes can also predispose to the slipping and cause degenerative spondylolisthesis.
Spondylolisthesis is also caused by bone disease and fractures. Some sports, such as weightlifting, gymnastics and soccer, on the lower back. They also demand that athletes tighten their backbones regularly. It can cause stress fractures in the spine. Stress fractures can weaken the spine and shift the place of bone.
Symptoms of spondylolisthesis vary. In the acute stage, no signs can occur. However, people with chronic diseases may not be able to carry out daily activities. Some common symptoms are:
- Persistent back pain
- Stiffness in the lower back and legs
- Muscle tension or muscle weakness in the lower limb (sciatica)
- Tenderness in the lower back
- Thigh hurts
- Tight muscles in the knees and buttocks
These symptoms are exacerbated by several activities such as standing, walking and resting.
- Degenerative spondylolisthesis: It occurs through arthritis when the joints lose their ability to maintain healthy spinal alignment. It can cause loosen vertebrae.
- Traumatic Spondylolisthesis: This is caused by injury or trauma to the spine. Fracture of the lamina and pedicles can cause the spine to slip forward.
- Pathological Spondylolisthesis: It is caused by diseases such as tumours or other bone diseases which cause structural weakness of the bones. This weakness causes the spine to slip forward.
- Dysplastic Spondylolisthesis: This is caused by congenital disabilities (present at birth) in the formation of parts of the spine called the facet. This defect causes the vertebra to move forward.
Isthmic Spondylolisthesis: This is caused by a defect in the vertebrae called pars interarticularis. This defect causes the vertebra to move forward.
Options for the Treatment Of Spondylolisthesis:
The choice to treat spondylolisthesis depends on various factors, including the patient’s age and general health, the severity of symptoms, and the degree of spinal slip. Treatment is usually conservative, including rest, medication and physiotherapy. Severe spondylolisthesis may require decompression laminectomy or spinal surgery.
- Medical Treatment: The person must take rest from sports and other activities until the pain subsides. Nonsteroidal anti-inflammatory NSAIDs recommended for pain relief and inflammation. Lumbar support or back support can be used to stabilise the lower back and relieve pain. Training and physiotherapy programs help improve painless movements and increase muscle mobility and strength.
- Physiotherapy: Stabilise exercises are the basis of treatment. These exercises strengthen the abdominal and back muscles and minimise the movement of the spine. It takes 8 to 12 weeks of aggressive daily care with stabilisation exercises to achieve clinical improvement.
- Surgery: Decompression and Fusion. Surgery may be needed if the pain does not decrease with conservative care and starts to interfere with daily activities or if the spine continues to disappear. The main goals of spondylolisthesis surgery are to relieve pain, improve the function of the spine, and increase the daily activities of the patient.
During surgery, the bones involved will be fixed with screws and rods and nerves which are getting pinched will be freed from compression. Sometimes artificial supports like cages will be introduced between the bones to consolidate the fusion process.
As a rule, two operations are performed to treat spondylolisthesis. The first operation is Decompression Laminectomy, which removes the part of the bone that presses on the nerve. The second operation is Spinal Fusion, which is done to ensure stability.
Note: For all the above three conditions, the diagnosis is the same. A spine surgeon will see the reports and let you know the condition that it is spondylosis, spondylolysis, or spondylolisthesis.
- Computerized tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
We think that this article is useful for you to know the difference between the three conditions related to the spinal cord and their treatments.
The majority of patients with spondylosis, spondylolysis and spondylolisthesis are free from pain and other symptoms after conservative or surgical treatment. In most cases, sports and other activities can be resumed gradually with few complications or recurrences.
To help prevent future injury, Doctor may recommend specific exercises to stretch and strengthen the back and abdominal muscles. Besides, to this, the patients must have regular check-ups as needed to make sure that problems do not develop in the future.
If you have any doubts regarding the above conditions or spinal conditions and are looking for the best treatment options, contact Dr Voleti Surya Prakash Rao Spine Surgeon.