If your back hurts when straining, after sitting for a long time or after getting up in the morning, spondylarthrosis may be the cause. This refers to wear and tear on the small joints of the spine. This is important: Not every MRI or X-ray image automatically explains the pain. The decisive factor is always the combination of symptoms, examination and imaging.
Brief summary: What is spondyloarthritis?
Spondylarthrosis is osteoarthritis of the small vertebral joints, also known as facet joints or vertebral arch joints. The disease is also known as facet joint arthrosis, vertebral joint arthrosis, facet arthrosis or spinal arthrosis.
Spondylarthrosis is a degenerative disease characterized by the wear and tear of the articular cartilage of the vertebral joints, which leads to pain and restricted movement. Typical symptoms are back pain, pain on starting, stiffness and restricted mobility. It mainly affects people from around the age of 50, but the first changes can begin earlier.
Diagnosis and therapy range from clinical examination, X-ray, MRI or CT to conservative treatment, infiltrations, minimally invasive procedures and only in selected cases surgery.
Definition & anatomy: What happens with spondyloarthritis?
In the case of spondylarthrosis, the vertebral joints change gradually. The joints are located in pairs at the back of the spine, to the right and left of the spinal canal. They connect the vertebral arches of neighboring vertebrae and guide the movements of the body.
The facet joints have articular surfaces with articular cartilage. This layer of cartilage normally ensures that movement remains possible with little friction. Together with intervertebral discs, ligaments and muscles, the facet joints stabilize each vertebral body.
During degeneration, the joint cartilage becomes thinner. The joint space can become narrower, the bone becomes denser and bony growths develop. Osteophytes, also known as bony protrusions, can form in spondyloarthritis and are a sign of degenerative changes in the spine. Spondylophytes can also develop on the side of the vertebral bodies; in findings, terms such as spondylosis, spondylosis deformans or signs of wear and tear are also used.
The pain is not only caused by the wear and tear itself. Irritated pain receptors in the joint capsule, synovial tissue and surrounding structures send signals to the nervous system. Inflammatory irritation can intensify this process.
Important: Spondyloarthritis often occurs together with other degenerative diseases of the spine, such as disc damage (discosis) and osteochondrosis. Osteochondrosis is a degenerative disease that affects both bone and cartilage and often occurs in the spine. Spondylarthrosis is part of a complex disease process that also includes other degenerative diseases of the spine such as spondylosis.
Causes and risk factors of spondyloarthritis
The causes are usually not a single trigger, but a combination of age, strain, tissue quality and movement behavior.
Important risk factors are
Age-related wear and tear: The most common cause is degeneration from the age of 40 to 50. In studies, many people showed degenerative findings from middle age onwards.
Primary and secondary forms: Primary spondyloarthritis develops without a clear starting point. Secondary forms develop after accidents, operations, malpositions or inflammatory diseases, for example.
Mechanical overload: Heavy physical work, frequent lifting, standing for long periods, sitting for long periods or working in forced postures increase the pressure on the vertebral joints.
Misalignments and instability: Scoliosis, pelvic obliquity or spondylolisthesis can put one-sided strain on individual joints.
Intervertebral disc wear: If intervertebral discs lose height, the load distribution changes. The facet joints then take on more pressure and can wear out more quickly.
Lifestyle factors: Obesity, lack of exercise, weak core muscles and smoking impair resilience and regeneration.
Previous damage: Accidents, previous operations or old sports injuries can accelerate wear and tear.
The main causes of spondylarthrosis are age-related wear and tear, overloading of the spine and degenerative diseases such as osteochondrosis and discosis.
Symptoms of spondylarthrosis (facet syndrome)
The painful symptoms are often referred to as facet syndrome. The symptoms can be unspecific at first and gradually worsen over time.
Back pain in spondylarthrosis is usually dull or drilling and occurs locally in the affected area of the spine. Many patients describe a deep-seated pain that is often pronounced on one side. The symptoms of spondylarthrosis can include back pain, start-up pain and restricted movement, which often occurs after prolonged periods of sitting or physical exertion.
Typical are:
Pain after prolonged standing, walking or sitting
Improvement at rest or with relief
Morning stiffness often occurs, so that the back feels stiff after getting up, but mobility improves after the first movements.
Pain when bending backwards, turning or straightening up
Muscle tension and relieving posture
Restricted movement in everyday life
Radiating symptoms are possible. If the lumbar spine is affected, the pain can radiate to the buttocks and legs, while if the cervical spine is affected, the pain can radiate to the shoulders and arms. If bony attachments press on surrounding nerves, neurological symptoms such as tingling or numbness may occur. Muscle weakness must also be clarified by a doctor.
An important note: not every radiologically visible spondyloarthritis causes symptoms. Studies show that many older people have clear changes in the image, but hardly any pain. For this reason, MRI findings alone are not enough to make a good treatment decision.
Regional differences in complaints (cervical spine, thoracic spine, lumbar spine)
Depending on the section of the spine, the symptoms vary.
Range | Typical complaints |
|---|---|
Cervical spine | Neck pain, shoulder tension, pain when turning the head, headaches, radiating to the arms |
Thoracic spine | Localized pain in the middle back, discomfort when turning or taking a deep breath; differentiation from heart or lung disease is important |
lumbar spine | Pain in the lower back, increasing when getting up from a sitting position, leaning backwards or standing for long periods, radiating to the buttocks or legs |
Regular, moderate exercise is the best remedy for chronic neck pain, which is often caused by a lack of exercise. This is especially true if there is no acute nerve compression. |
Diagnostics: How is spondyloarthritis diagnosed?
Careful diagnostics clarify whether the facet joints are really responsible for the symptoms. In orthopaedics, the rule is: first understand, then treat.
The clarification includes:
Medical history: The doctor asks about the duration, location, triggers, sleep, occupation, old injuries, previous operations and concomitant illnesses.
Clinical examination: posture, gait, mobility, muscle strength, reflexes and sensitivity are examined.
Provocation tests: Stretching and rotating movements can put targeted strain on the facet joints.
X-ray: It shows joint space narrowing, spondylophytes, misalignments and changes in the vertebral body.
MRI: It assesses intervertebral discs, nerves, soft tissue, signs of inflammation and the spinal canal.
CT: It is helpful for unclear bony findings or before targeted interventions.
A diagnostic infiltration can provide additional information. An anesthetic is injected into the suspected facet joint. If the symptoms subside significantly, this indicates that this joint is involved. Specialist associations often discuss pain relief of around 50 to 80 percent as a guide; the exact assessment remains individual.
Conservative therapy: What helps without surgery?
In most cases, treatment begins conservatively. The aim is not to “magic away” the wear and tear, but to alleviate pain, improve mobility, build up muscles and relieve the vertebral joints.
The treatment options for spondyloarthritis are divided into symptomatic and causal therapies, with non-surgical therapies usually being recommended first. Symptomatic means: pain and inflammation are reduced. Causal means: stress factors such as excess weight, lack of exercise, instability or unfavorable posture are improved.
Important building blocks are:
Medication: NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or diclofenac relieve pain and inhibit inflammatory processes. Their use should be limited in time and medically coordinated.
Physiotherapy: Targeted exercises strengthen the back and abdominal muscles, improve coordination and stabilize the spine.
Exercise: Regular, gentle exercise is crucial for relieving the pain of spondyloarthritis. Walking, cycling, swimming and aqua gymnastics are suitable.
Stretching: Exercises to stretch the neck and back muscles can help to relieve the pain of spondyloarthritis and improve mobility.
Fascia: Fascia rolling massages can reduce muscular tension in the back and promote the supply of nutrients to the tissue, which is helpful for spondyloarthritis.
Weight: Weight reduction reduces the mechanical pressure on the vertebral joints.
Ergonomics: Good seating furniture, changing working positions, height-adjustable desks and breaks during sedentary work are helpful.
Diet: An anti-inflammatory diet with plenty of fresh vegetables, fruit and omega-3 fatty acids can reduce inflammation in the body.
Pain management: Relaxation, mindfulness and progressive muscle relaxation help to reduce chronic pain tension.
Practical tips: Change position regularly when working, lift loads close to your body, do not exercise into the pain and do not compare spondyloarthritis with osteoarthritis of the knee or shoulder. The principles are similar, but the spine reacts differently.
However, the above measures do not replace an individual examination.
Injections and facet infiltration
If conservative measures are not sufficient, infiltrations can help. Non-surgical therapies include infiltrations, in which painkillers are injected directly into the affected regions under X-ray control.
During a facet joint infiltration, a local anesthetic and sometimes cortisone are applied to the irritated vertebral joint. This is usually carried out under X-ray or CT control. The aim is to reduce pain for weeks to months and make physiotherapy more possible again.
Periradicular therapy, or PRT for short, is aimed at irritated nerve roots in the area of the spinal canal. Pain specialists may consider interventional pain therapies if symptoms are severe. The number of such interventions per year is limited; the benefits and risks are always weighed up personally.
Facet denervation (thermocoagulation)
Minimally invasive procedures can be used when conservative methods are not sufficient. Facet denervation is a minimally invasive method of treating spondyloarthritis in which the pain fibers in the area of the arthritic joint are obliterated.
In facet denervation, also known as thermocoagulation or radiofrequency therapy, the doctor inserts fine probes into the pain-conducting nerve branches under image control. Heat interrupts the pain transmission there. The joint wear and tear remains, but the pain can be significantly reduced.
The effect can last for several months to years. As nerves can grow back, it is possible to repeat the procedure. The procedure is most useful for chronic, easily localized complaints after a clear diagnosis.
Surgical treatment: When is surgery advisable?
Surgery is only necessary for a small proportion of patients with spondyloarthritis. Specialized clinics therefore first check whether conservative or minimally invasive methods are sufficient. Good spinal surgery does not automatically mean surgery, but a clean decision.
Surgery can be useful for
pronounced instability of the spine
severe narrowing of the spinal canal
Significant neurological deficits
Severe, persistent pain despite consistent therapy
Structural malpositions with relevant restriction
During a decompression, the surgeon removes bony constrictions, thickened joint parts or ligament structures in order to relieve pressure on nerve roots. In a spondylodesis, two or more vertebrae are stably connected with screws, rods and, if necessary, a cage.
Such interventions can improve quality of life, but involve risks and rehabilitation. The decision should always be made after a personal consultation, up-to-date imaging and a clear objective. At the Spine Clinic Berlin, the principle is: as much as necessary, as little as possible.
Progression, prognosis and prevention
Spondyloarthritis is a chronic wear and tear disease. It is usually not curable in the sense of new joint cartilage. However, its progression can often be significantly influenced.
Some people only have occasional complaints. Others develop chronic pain, sleep problems, exhaustion or depressive moods. Early support then makes sense, because the body and mind work closely together in chronic pain.
Prevention and long-term stabilization are best achieved through:
Regular back exercises
Back and posture training
less continuous sitting
ergonomic workplace
Back-friendly sports
Weight reduction for overweight
Stop smoking
Medical clarification for persistent back pain
The most important step is often to take a calm, close look at the cause. If you have persistent complaints or have already received a diagnosis, have the findings assessed by a specialist. A second opinion can help to avoid unnecessary interventions and find the right treatment.
