yogabook / pathologie / spondylarthrosis

spondylarthrosis

Definition of

Arthrotic degeneration of the spine. This includes changes to the facet joints (vertebral joints) and changes to the intervertebral discs and adjacent vertebral bodies. With increasing age, the intervertebral discs change adversely in several ways: the proteoglycan content of the nucleus pulposus decreases, which reduces the water-binding capacity (swelling capacity), and the collagen content increases, which makes the nucleus pulposus firmer and harder. In addition, defects develop in the annulus fibrosus, in which the fibrous tissue arranges itself into fibrils, which can allow the passage of material from the nucleus pulposus (prolapse). Overall, the intervertebral disc loses height, which corresponds to the decrease in body height with ageing, even without a change in the shape of the spinal column, for example due to hyperkyphosis of the thoracic spine. The decreasing water-binding capacity (swelling capacity) tends on the one hand to cause the intervertebral disc to partially leave its original area in the direction beyond its edges (protrusion), which can compress spinal roots, and on the other hand to cause the less even distribution of pressure to damage the top and bottom plates of the vertebral bodies, which favors the formation of osteophytes at the edges, which can form bone braces (partial ossification of the intervertebral space next to the intervertebral discs). Predilection sites are the most stressed areas of the spine, i.e. the cervical spine and especially the lumbar spine including the lower thoracolumbar spine (thoracolumbar transition). These pathogenic tendencies, which are more or less present in every person, may be accelerated and intensified by their movement behavior: lack of movement and frequent identical postures over long periods of time on the one hand and overloading on the other can lead to massively accelerated degeneration.

As with all osteoarthritis, degeneration or wear of the physiological hyaline cartilage occurs first, the joint cartilage loses height and smoothness, which roughens it. Friction at the edges of the cartilage surfaces, particularly due to movements or postures at the end of the joint, accelerates this process. In the later stages, this is replaced by less durable and coarser fibrous cartilage, and even later this can no longer withstand the load and the bones in the now cartilage-free areas are attacked. It is not uncommon for osteophytes (spondylophytes) to form at the edge of the joint space, based on cartilage material expelled from the joint space, which accumulates and calcifies outside the joint space. Depending on their size and position, these osteophytes can press on neighboring structures, especially the facet joint nerves. As these are branches of the outgoing spinal nerves, pseudoradicular symptoms occur, the picture of a facet syndrome. In this case, the pain is similar to neuroradicular pain, but there is no disturbance of afferents (e.g. sensitivity) or efferents (e.g. innervation of muscles, organs). If there is also an ostophytic narrowing of the spinal canal, more severe disorders develop as spinal canal stenosis, as well as when the longitudinal anterior ligament cannot withstand the chronic pressure of a dorsal protrusion(protrusio) and the spinal cord is compressed as a result. If the swollen joint capsule presses on a spinal nerve, neuroradicular pain occurs, possibly with afferent or efferent disorders. Depending on the level of the affected area, a picture of ischialgia, lumbalgia (lumbar spine) or cervicobrachialgia (cervical spine) may be seen. Osteophytes can also cause crepitation and restricted movement.

Spondyloarthritis is a common disease of the spine, the incidence of which clearly increases with age. It can also occur, largely independent of age, in the context of rheumatoid arthritis.

Cause

1. Traumas
2. pre-existing disc hernias
3. Diseases of the spine: tumors, inflammation
4. age-related degeneration
5. Damage to the ligamentous apparatus

Predisposition

1. Lack of exercise
2. Chronic incorrect and excessive strain at work, hobby, sport
3. Occupations and activities where the head is often tilted forward for a long time, such as hairdresser, kindergarten teacher (cervical form)
4. Diseases of the spinal column such as disc hernias with a lack of movement due to physical inactivity, instabilities of the spinal column
5. Scoliosis, hyperlordosis (lumbar spine, cervical spine) and other shape anomalies
6. Osteoporosis
7. RA and rheumatoid arthritis
8. Lack of muscular support in the trunk
9. Obesity (especially lumbar form)

Diagnosis

1. The blood laboratory is o.B. except in cases of synovitis.
2. X-ray shows the loss of height of the intervertebral space, osteophytes and bone braces
3. CT (here better than MRI) for more precise imaging

Symptoms

1. Localized back pain, localized in the spine, usually as pain on exertion, less often as pain at rest:
   – in lumbar form in the area of the lower back, often additional tension; pain increases after prolonged walking or standing, possibly ischialgiform pain
   – in the case of the vertebral form in the cervical spine and neck, possibly also visual disturbances, headaches, dizziness, tinnitus
2. with nerve root compression syndrome also neuroradicular pain radiation into the pore region and leg, possibly neurological deficits
3. Painful restriction of movement
4. If necessary, adopt a relaxed posture
5. possibly „vertebral blockages“, i.e. blockages of spinal segments
6. Increased pain on exertion, such as flexion of the back under load, bending over
7. Morning stiffness of the WS, if applicable

Complications

1. Spinal canal stenosis
2. Nerve root compression syndrome
3. Depression and other mental disorders

DD

1. Spondylodiscitis
2. Spondylitis
3. Spinal canal stenosis
4. Spondylolisthesis

Therapy

1. No known causal therapy
2. Symptomatic therapy, e.g. pain therapy, PT
3. Exercise therapy, especially strengthening training for the back
4. Electrotherapy (stimulation current therapy)
5. Balneotherapy
6. Acupuncture
7. Trigger point treatment
8. Local infiltrations, if necessary under imaging control
9. Therapy of existing obesity if necessary
10. If necessary, facet denervation if conservative methods fail (radiofrequency neurotomy)
11. if necessary: Widening of the spinal canal or arthrodesis
12. Life expectancy is not reduced. With consistent conservative therapy, a high degree of symptom reduction or freedom can usually be achieved.