Spondylosis Treatment Options
What is spondylosis of the spine?
Spondylosis is osteoarthritis of the spine. It can affect the cervical, thoracic or lumbar spine. It may be called spinal arthritis, spinal stenosis, degenerative spondylosis, degenerative disc disease, or age-related wear and tear that affects the intervertebral discs, the facet joints on the vertebrae, and spinal ligaments. Spondylosis is a chronic, progressive deterioration of the spine related to aging.
Spondylosis is almost inevitable with age. It typically affects people over the age of 50 but the first symptoms may appear thirty years before diagnosis. Spondylosis is the cause of spinal stenosis which is narrowing of the constriction of nerves and/or the spinal cord due to overgrowth of bone and ligaments.
X-ray evidence of degeneration occurs in virtually all people as they age. Many people have no symptoms; however, some individuals do have symptoms of nerve root and spinal cord compression and pain. Spondylosis symptoms can include radiculopathy, a pinched nerve, and/or compression and inflammation of the spinal cord called myelopathy.
Often the pain from spondylosis is manageable without surgery. However, a serious complication of spondylosis is when the degenerative changes cause pressure on the nerve roots and/or spinal cord. The cervical and lumbar areas are mainly affected with the thoracic area much less involved. Lumbar spinal stenosis is a common cause of sciatica,
What are the treatment options?
Symptomatic spondylosis is initially managed nonsurgically which usually improves pain and function. Nonsurgical management includes anti-inflammatory medications, and physical therapy. When spondylosis occurs in the neck, use of a cervical collar can be helpful.
Minimally invasive non-surgical procedures such as epidural injections may use steroids and anesthetics that are injected into the facet joints, trigger points or intervertebral disc spaces to manage acute pain. Radiofrequency nerve ablation (RFA) may be used to destroy small painful nerves.
What are the indications for surgery?
Surgery may be indicated when there is severe or disabling pain, clinically significant dysfunction like weakness in the arms or legs, tinging in the hands and fingers, imbalance issues, changes in fine motor skills, and gait changes; or when there is spinal cord compression.
Surgical treatment is meant to halt progression of nerve/spinal cord deterioration and further neurologic deficit allowing for improvement in pain and rehabilitation potential. When surgery is necessary, our Dallas Neurosurgical & Spine neurosurgeons routinely use state-of-the-art minimally invasive surgical techniques.
Surgery treatment options for lumbar spondylosis
Lumbar Decompression techniques include:
- Laminectomy – During a laminectomy the bony arches of the spine are removed to increase space for the spinal canal to decrease pressure.
- Discectomy – during this procedure a portion of the herniated disc is removed to relieve pressure on a nerve root or the spinal canal.
- Foraminotomy or foraminectomy – During this procedure the foramen are expanded to relieve pressure.
- Osteophyte (bone spurs) removal is a procedure to remove bone spurs that are causing the compression and pinched nerves.
- When there is only a pinched nerve, conservative management will be recommended. When this approach is ineffective, surgical decompression may be recommended. If the spine requires stabilization, surgery will involve spinal fusion.
Surgical treatment options for cervical spondylosis
Surgery will be recommended when there is spinal cord injury due to degenerative disease from bone spurs, and/or herniated discs in the cervical spine. Cervical spondylosis with spinal cord injury requires surgical treatment. Frequently, decompression surgery can cause the spine to become unstable. Degeneration only occurs at the level where there is motion. Thus, spinal fusion is intended to eliminate motion by fusing together the vertebrae with a bone graft and metal parts.
Cervical decompression techniques include:
- Anterior cervical discectomy and bone graft fusion (ACDF) is a safe and effective surgery for the treatment of degenerative cervical spine disease. In this surgery, the DNS surgeon removes the damaged disc, and any arthritic bone spurs and the spine is fused.
- Anterior cervical corpectomy and fusion involves removal of the damaged disc and additional bone after which the spine is stabilized with fusion.
- Anterior cervical discectomy and disc replacement involves removal of the damaged disc, bone spurs and an artificial disc will replace the damaged disc.
- Posterior laminectomy and fusion involve the removal of the bony arch of the vertebra, bone spurs and ligaments that are compressing the spinal cord. This also usually requires spinal fusion.
- Laminoplasty is a procedure to decompress the spinal cord while preserving some motion and avoids spinal fusion.
- Some patients will require a combination of anterior and posterior approaches to treat severe osteoporosis or multiple level degeneration.
*Note that the anterior techniques approach treatment from the front of the neck. Posterior techniques approach treatment from the back of the neck. When the spine is fused, it can take up to a year for the bone graft to heal.
The neurosurgeons at Dallas Neurosurgical & Spine will explain in detail the procedure(s) for each patient with complications and risks. Your surgical team will employ minimally invasive surgery whenever possible.
What about minimally invasive spine surgery?
Spine surgery is often done as an open procedure so that the surgeon can visualize and access the operating area, however, it may require long incisions and the risk of significant damage to surrounding tissues. To avoid these issues, minimally invasive spine surgery techniques have been created.
Minimally invasive spine surgery uses a high-powered microscope and computer assisted intraoperative real time imaging to perform accurate and safe surgery. Endoscopic disc surgery can also be advantageous.
The advantages of minimally invasive spine surgery include:
- smaller incisions
- less blood loss
- less harm to surrounding soft tissues
- less pain
- faster recovery and shorter hospital stays.
You Dallas Neurosurgical & Spine surgical team will employ minimally invasive surgery whenever possible. Contact us to schedule a consultation to learn about your spinal condition and all your treatment options.