Spondylosis is common, but not automatically dangerous. The decisive factor is whether the changes really match the symptoms. Good medicine therefore begins with a precise diagnosis: first understand, then treat.
Brief overview: Spondylosis at a glance
Spondylosis describes degenerative changes in the spine. It mainly affects intervertebral discs, vertebral bodies, vertebral joints and ligaments. This wear and tear increases with age, but can go unnoticed for a long time.
Definition: Wear and tear on intervertebral discs, vertebrae and joints; also known medically as spondylosis.
Common area: neck, nape and lumbar spine; thoracic spine less common.
Typical age: often visible from 40-50 years, very common in older age.
Not every spondylosis visible on X-ray causes pain.
Leading symptoms: back pain, neck pain, stiffness, restricted movement, rarely neurological deficits.
Diagnosis: examination, X-ray, CT, magnetic resonance imaging MRI or magnetic resonance imaging.
Treatment: usually conservative; surgery is rarely necessary.
In short: spondylosis cannot be reversed, but it can be treated effectively with conservative therapies. Does surgery have to be performed? Usually not.
What is spondylosis - definition and forms
Spondylosis is a collective term for signs of wear and tear of the spine and is one of the most common degenerative spinal diseases. Spondylarthrosis refers more to osteoarthritis of the small vertebral joints; vertebral joint arthrosis and facet syndrome often describe painful facet joints. Osteochondrosis tends to affect the intervertebral disc and adjacent bones.
In spondylosis deformans, bony growths, so-called spondylophytes or osteophytes, develop. These can initially exist without inflammation and without symptoms. Spondylosis can occur throughout the spine, but particularly in the cervical and lumbar spine. The severity and intensity of the symptoms depend greatly on the affected section of the spine. Only when nerves, nerve roots or the spinal cord are constricted do more severe symptoms often arise.
How spondylosis develops - causes and risk factors
Over the years, the intervertebral discs lose fluid and become narrower, which leads to a loss of stability in the spine. Age-related wear and tear leads to changes in the intervertebral discs, which lose their elasticity and thus increase the load on the vertebral bodies.
The body forms bony outgrowths (spondylophytes) at the edges of the vertebrae to compensate for instability. This reaction stabilizes in the short term, but can reduce the space for nerves in the long term.
Important causes and triggers are
Overweight and overloading of the spine through sport, frequent bending or heavy lifting
Prolonged sitting, unfavorable posture and poor posture
Lack of exercise, smoking, genetic predisposition
Injuries, osteoporosis, diabetes or other illnesses
A special form is spondylosis hyperostotica with pronounced ossifications along the spine.
Changes to the spine, intervertebral discs and vertebral bodies
Spondylosis changes the architecture of the spine, particularly frequently in the lumbar spine with typical complaints of the lower back. Intervertebral discs lose their buffer function, vertebral segments sink, bones become denser under joint surfaces and osteophytes develop at the edges.
The facet joints bear more weight due to changes in load distribution. This can promote instability, spondylarthrosis, facet syndrome and increased stress on the vertebral joints. Thickened ligaments can also constrict the spinal canal or nerve exit holes.
Spinal canal stenosis occurs when bony protrusions grow in the direction of the spinal canal or nerve exit holes. Such processes develop over the course of many years and are often only visible on X-ray at first. Spondylosis can often be detected as an incidental finding during X-ray examinations without the patient showing any symptoms.
Typical symptoms and progression of spondylosis
Spondylosis can lead to back pain and restricted movement, with pain often occurring in the neck and lower back. Back pain from spondylosis is often dull or aching and increases with exertion, prolonged standing or sitting. The back pain caused by spondylosis can worsen if the back is subjected to additional strain due to unfavorable working positions.
Start-up pain manifests itself in severe pain and stiffness in the morning or after long periods of rest. Restricted movement leads to noticeable stiffness in the spine, which makes turning or bending difficult. Moderate movement often brings improvement.
If the spondylosis is severe, neurological symptoms such as numbness or tingling may occur, especially if nerve roots are compressed. Arms, legs, strength and walking can also be affected. Neurological deficits such as paralysis or incontinence require immediate medical attention.
Diagnosis of spondylosis: Examinations and imaging
If back or neck pain persists, it makes sense to see a doctor. In orthopaedics, the diagnosis begins with a medical history: Where is the pain located? How long has it been there? What kind of strain is there in everyday life, work or sport?
The physical examination checks posture, mobility, muscle tension, reflexes, sensitivity and strength. X-rays show bony changes, reduced disc height and deformities. Spondylosis is usually diagnosed using imaging procedures such as X-rays, computer tomography (CT) and magnetic resonance imaging (MRI). MRI and CT assess the intervertebral discs, spinal canal, spinal canal, nerves and facet joints more precisely and form the basis of individual spinal therapies with conservative and surgical procedures.
In addition to imaging procedures, a blood test can be carried out to rule out inflammatory diseases that can cause similar symptoms. If the pain is unclear, a diagnostic blockade of the facet joints can help.
Treatment of spondylosis: Conservative and surgical
The treatment of spondylosis aims to relieve pain and improve the mobility of the spine. The aim is not only to reduce pain, but also to improve quality of life.
Conservative therapy concepts include:
NSAIDs: The use of non-steroidal anti-inflammatory drugs (NSAIDs) helps to reduce pain and inflammation in spondylosis.
Physiotherapy: Conservative therapy for the treatment of spondylosis includes physiotherapy to strengthen the trunk muscles.
Manual therapy, heat, cold and adapted activity.
Infiltrations of facet joints with local anesthetic, sometimes cortisone.
Thermal procedures or facet denervation when small nerve branches conduct pain.
Physiotherapy and targeted exercises are often part of the treatment to strengthen the back muscles and promote the stability of the spine. Guidelines from the German Spine Society recommend surgery only after conservative methods have failed. It is precisely then that an independent orthopaedic second opinion on spinal surgery often makes sense. As a rule, surgery is only considered in cases of severe neurological deficits and ineffectiveness of conservative therapies. In severe cases, surgical therapy may be necessary to relieve pressure on the spinal cord or nerves, for example by removing bony outgrowths. This includes decompression, removal of spondylophytes or, in cases of instability, fusion.
Core stability, training and lifestyle: what those affected can do themselves
A stable spine requires strong abdominal, back, gluteal and hip muscles. Regular exercise and targeted training of the back and abdominal muscles increase the stability of the spine and can counteract the development of spondylosis.
Walking, cycling, swimming, gentle strength training and physiotherapy exercises are helpful. Patients should be given a program that can be continued safely at home.
An ergonomic workplace design and an appropriate posture for everyday activities are important to prevent spondylosis. Frequent changes of position, breaks while sitting and no heavy lifting will relieve the strain on the back. A healthy body weight relieves pressure on the joints and spine, which can reduce the risk of spondylosis. A low-inflammatory diet also supports health.
Frequently asked questions about spondylosis
How common is spondylosis?
With increasing age, many people show visible degenerative changes. Despite this, many of those affected have no symptoms.
Can spondylosis be cured?
Structural changes remain. However, pain, stiffness and function can often be significantly improved.
Which sport is suitable?
Walking, swimming, cycling and gentle strength training are suitable. Jerky twisting movements and heavy lifting with pain are particularly unfavorable.
When to see a doctor immediately?
In the event of paralysis, numbness, gait instability, bladder or bowel dysfunction, severe night-time pain or rapid deterioration. Sick leave depends on the pain, occupation and findings.
What is the prognosis?
Many sufferers achieve a good quality of life with a clear diagnosis, consistent treatment and active cooperation. If you are unsure whether your findings match your symptoms, have them carefully classified by a doctor.
