osteochondrosis

Prepared By :
Ammar Asif Bin Abdul Aziz
Group 84

 Osteoarthritis

is a disease of the joints. Also

know as degenerative joint disease, it is the
most common form of arthritis, affecting
more than 20 million American adults. It
should not be confused with rheumatoid
arthritis, which is not the same as
osteoarthritis. Osteoarthritis is caused by a
breakdown of cartilage, the substance that
provides a cushion between the bones of the
joints. Healthy cartilage allows bones to
glide over one another and acts as a shock
absorber during physical movement. In
osteoarthritis, the cartilage breaks down and
wears away. This causes the bones under the
cartilage to rub together, causing pain,
swelling and loss of motion of the joint.

What Causes Osteoarthritis?

Most cases of osteoarthritis have no known cause.
Risk factors include:
Age osteoarthritis affects more people over the
age of 45
Female osteoarthritis is more common in
women than in men
Certain hereditary conditions such as defective
cartilage and joint deformity
Joint injuries caused by sports, work-related
activity or accidents
Obesity
Diseases that affect the structure and function of
cartilage, such as rheumatoid arthritis,
hemochromatosis (a metabolic disorder), Paget's
disease and gout

Signs and Symptoms of Osteoarthritis

Osteoarthritis usually begins slowly. Early in the disease, joints

may ache after physical work or exercise. Often the pain of early
osteoarthritis fades and then returns over time, especially if the
affected joint is overused. Other symptoms may include:
Swelling or tenderness in one or more joints, especially before
or during a change in the weather
Loss of flexibility of a joint
Stiffness after getting out of bed
A crunching feeling or sound of bone rubbing on bone
Bony lumps on the joints of the fingers or the base of the thumb
Steady or intermittent pain in a joint (although not everyone
with osteoarthritis has pain)

What Is Spondylosis? What Is Spondylosis?

Spondylosis (spinal osteoarthritis) is a degenerative disorder
that may cause loss of normal spinal structure and function.
Although aging is the primary cause, the location and rate of
degeneration is individual. The degenerative process of
spondylosis may impact the cervical, thoracic, and/or lumbar
regions of the spine affecting the intervertebral discs and facet
joints.

What Is Spondylosis? What Is

Spondylosis?

Spondylosis (spinal osteoarthritis) is

a degenerative disorder that may
cause loss of normal spinal structure
and function. Although aging is the
primary cause, the location and rate
of degeneration is individual. The
degenerative process of spondylosis
may impact the cervical, thoracic,
and/or lumbar regions of the spine
affecting the intervertebral discs and
facet joints.

 Spondylosis

often affects the

following spinal
elements:

Intervertebral Discs and Spondylosis

As people age certain biochemical changes occur affecting tissue

found throughout the body. In the spine, the structure of the
intervertebral discs (anulus fibrosus, lamellae, nucleus pulposus)
may be compromised. The anulus fibrosus (e.g. tire-like) is
composed of 60 or more concentric bands of collagen fiber termed
lamellae. The nucleus pulposus is a gel-like substance inside the
intervertebral disc encased by the anulus fibrosus. Collagen fibers
form the nucleus along with water, and proteoglycans.
The degenerative effects from aging may weaken the structure of
the anulus fibrosus causing the 'tire tread' to wear or tear. The
water content of the nucleus decreases with age affecting its
ability to rebound following compression (e.g. shock absorbing
quality). The structural alterations from degeneration may
decrease disc height and increase the risk for disc herniation.

Facet Joints (or Zygapophyseal Joints) and

Spondylosis

The facet joints are also termed zygapophyseal joints. Each

vertebral body has four facet joints that work like hinges. These
are the articulating (moving) joints of the spine enabling
extension, flexion, and rotation. Like other joints, the bony
articulating surfaces are coated with cartilage. Cartilage is a
special type of connective tissue that provides a self-lubricating
low-friction gliding surface. Facet joint degeneration causes loss of
cartilage and formation of osteophytes (e.g. bone spurs). These
changes may cause hypertrophy or osteoarthritis, also known as
degenerative joint disease.

Bones and Ligaments

Osteophytes (e.g. bone spurs) may form adjacent to the end

plates, which may compromise blood supply to the
vertebra. Further, the end plates may stiffen due to
sclerosis; a thickening/hardening of the bone under the end
plates.
Ligaments are bands of fibrous tissue connecting spinal
structures (e.g. vertebrae) and protect against the extremes
of motion (e.g. hyperextension). However, degenerative
changes may cause ligaments to lose some of their
strength. The ligamentum flavum (a primary spinal
ligament) may thicken and/or buckle posteriorly (behind)
toward the dura mater (a spinal cord membrane).

Cervical Spine and Spondylosis

The complexity of the cervical anatomy and its wide range

of motion make this spinal segment susceptible to disorders
associated with degenerative change. Neck pain from
spondylosis is common. The pain may spread (radiate) into
the shoulder or down the arm. When a bone spur
(osteophyte) causes nerve root compression, extremity (e.g.
arm) weakness may result. In rare cases, bone spurs that
form at the front of the cervical spine, may cause difficult
swallowing (dysphagia).

Thoracic Spine and Spondylosis

Pain associated with degenerative disease is often

triggered by forward flexion and hyperextension. In the
thoracic spine disc pain may be caused by flexion facet pain by hyperextension.
Lumbar Spine and Spondylosis
Spondylosis often affects the lumbar spine in people
over the age of 40. Pain and morning stiffness are
common complaints. Usually multiple levels are
involved (e.g. more than one vertebrae).
The lumbar spine carries most of the body's weight.
Therefore, when degenerative forces compromise its
structural integrity, symptoms including pain may
accompany activity. Movement stimulates pain fibers
in the anulus fibrosus and facet joints. Sitting for
prolonged periods of time may cause pain and other
symptoms due to pressure on the lumbar vertebrae.
Repetitive movements such as lifting and bending (e.g.
manual labor) may increase pain.

Spondylosis Diagnosis

Neurologic Evaluation
A neurologic evaluation assesses the patient's
symptoms including pain, numbness, paresthesias (e.g.
tingling), extremity sensation and motor function,
muscle spasm, weakness, and bowel/bladder changes.
Particular attention may be given to the extremities.
Either a CT Scan or MRI study may be required if there
is evidence of neurologic dysfunction.
X-Rays and Other Tests
Any patient experiencing back pain or stiffness in a
joint or joints for more than two weeks should see his
or her physician for an evaluation. The evaluation
usually consists of a discussion of symptoms and a
detailed medical history, a physical examination and
if osteoarthritis is suspecteda series of x rays. Other
tests (blood tests, MRI or CT scans) may be performed
to confirm the presence of spinal arthritis or to rule out
other conditions that can cause similar symptoms, such
as a tumor, infection, fracture, or other types of
arthritis.

Diagnosing spinal osteoarthritis

Typically, the physician will use a combination of
findings from a patients medical history, physical exam
and medical tests to accurately diagnose whether a
patient has osteoarthritis. An accurate diagnosis is very
important for guiding the selection of treatment options
and for actually helping relieve the pain and
discomfort associated with the patients condition.
Physical Examination
A thorough physical examination reveals a lot about
the health and general fitness of the patient. The exam
includes a review of the patient's medical and family
history. Often laboratory tests such as complete blood
count and urinalysis are ordered. The physical exam
may include:
Palpation (exam by touch) determines spinal
abnormalities, areas of tenderness, and muscle spasm.
Range of Motion measures the degree to which a
patient can perform movement of flexion, extension,
lateral bending, and spinal rotation.

Medical history. The patient will be asked to describe his

or her symptoms, such as a description of the pain, stiffness

and joint function, when and how the symptoms started,
and how the symptoms have changed over time. The
patient should also discuss how the symptoms affect his or
her everyday life and work activities. The doctor also needs
to know about the patients other medical conditions,
current medications, past experience with other treatments,
family history, and general lifestyle habits (such as alcohol
intake, smoking, etc.). When dealing with pain problems,
the doctor is likely to ask key questions related to those
things that reliably cause or aggravate the pain and those
that reliably bring relief or prevent the pain. Other questions
may relate to certain lifestyle topics, such as exercise,
nutrition and activities for diversion, sports, etc.
Physical examination. The doctor will conduct a physical
exam to assess the patients overall general health,
musculoskeletal status, nerve function, reflexes and direct
evaluation of the problematic joints in the back. The doctor
will be looking at muscle strength, flexibility, and the
patients ability to carry out daily living activities such as
walking, bending, and reaching. The patient may also be
asked to perform some exercises to test range of motion
and determine whether pain worsens during any particular
type of movement.

X-rays. The doctor will likely order an x-ray to see if there is

joint damage and how much joint damage has occurred. The xray can show cartilage loss, bone damage, and the presence
and location of bone spurs. X-rays are also useful in helping to
exclude other causes of pain and to better inform possible
considerations about surgery. However, it is important to keep
in mind that what shows up in an x-ray may not correlate to the
presence or absence of osteoarthritis and associated pain. For
example, most people over age 60 have degenerative changes
in their spine consistent with osteoarthritis, but for perhaps
85% of them there is no pain or stiffness. Conversely, an x-ray
conducted during the early stages of osteoarthritis may not yet
show any visible damage to the joints. For all these reasons,
the clinical history and physical examination are essential to
arriving at an accurate clinical diagnosis and plan of treatment.
Other tests may also be used to rule out conditions other than
osteoarthritis that may be causing the patients symptoms. For
example, blood tests are used to exclude diseases that can
cause secondary osteoarthritis or other types of arthritis that
simulate osteoarthritis. Joint aspiration, where fluid is drawn
from the joints through a needle for examination, can help rule
out conditions such as infections or gout.

Additional tests that may be needed to rule out

other causes of pain or to identify the presence of
arthritis bone
with scan,
more used
sophistication
than an x-ray
can
A radioactive
to rule out inflammation,
a tumor,

infection or a small fracture. With a bone scan, the radioactive

tracer
material is injected intravenously and then is concentrated
include:
by the body where there is high metabolism or bone turnover. If
something suspicious is found on the bone scan, it is usually
followed by a CT or MRI scan to distinguish what the bone lesion
might represent, since the bone scan alone cannot distinguish
among tumors, infections or fractures.
A CT scan may be used to better show the adequacy of the spinal
canal and surrounding structures. A CT scan may also include
myelography, where an x-ray contrast dye is injected into the spinal
column to show structures such as a bulging disc or bone spur
possibly pressing on the spinal cord or nerves.
The MRI or magnetic resonance imaging scan, is a very sophisticated
imaging method that can show great anatomic details of the spinal
cord, nerve roots, discs, ligaments and surrounding tissues and
spaces. Most MRI studies require the patient to lie flat in a tube for
about 40 minutes, although open frame and even standing MRI
scanners exist and seem particularly appropriate for patients having
claustrophobia (fear of tight spaces). MRI scans can be adjusted to
show different tissues including their water content, important in
determining disc degeneration, infections or tumors. The goal of all
diagnostic studies is to discover patterns or confirmations between
the various tests that point to a clear diagnosis among various
possible ones.

The key is to diagnose the condition causing the patients

pain and disability and to guide appropriate treatment,
including psychological, physical, medical and/or surgical.
Diagnosis is a detective hunt for causes and effects with
the goal of improved treatment.

Radiographs (x-rays) may indicate loss of vertebral disc

height and the presence of osteophytes, but is not as
useful as a CT Scan or MRI.
The CT Scan may be used to reveal the bony changes
associated with spondylosis. An MRI is a sensitive imaging
tool capable of revealing disc, ligament, and nerve
abnormalities.
Discography seeks to reproduce the patient's symptoms to
identify the anatomical source of pain. Facet blocks work in
a similar manner. Both are considered controversial.
The physician compares the patient's symptoms to the
findings to formulate a diagnosis and treatment plan.
Further, the results from the examination provide a
baseline from which the physician can monitor and
measure the patient's progress.

Treatment

Conservative treatment is successful 75% of the time. Some

patients may think that because their condition is labeled
degenerative they are doomed to end up in a wheel chair some
day. This is seldom the case. Many patients find their pain and
other symptoms can be effectively treated without surgery.
During the acute phase, anti-inflammatory agents, analgesics,
and muscle relaxants may be prescribed for a short period of
time. The affected area may be immobilized and/or braced.
Soft cervical collars may be used to restrict movement and
alleviate pain. Lumbosacral orthotics may decrease the lumbar
load by stabilizing the lumbar spine. In physical therapy, heat,
electrical stimulation, and other modalities may be
incorporated into the treatment plan to control muscle spasm
and pain.
Physical Therapy (PT) teaches the patient how to strengthen
their paravertebral and abdominal muscles to lend support to
the spine. Isometric exercises can be helpful when movement
is painful or difficult. Exercise in general helps to build strength,
flexibility, and increase range of motion.
Lifestyle modification may be necessary. This may include an
occupational change (e.g. from manual labor), losing weight,
and quitting smoking.

Surgery
Seldom is surgery used to treat spondylosis or spinal osteoarthritis.
Conservative forms of treatment are tried first.
If there is neurologic deficit, certain surgical procedures may be
considered. However, before surgery is recommended, the
patient's age, lifestyle, occupation, and number of vertebral
levels involved are carefully evaluated.
A spinal physician is able to determine if surgery is the best
treatment for the patient.

Recovery

Always follow the instructions provided by the physician and/or

physical therapist. This includes:
Take medication as directed. Report side effects to your physician
immediately.
Follow the home exercise program provided by the physical
therapist.
Avoid heavy lifting and activities that aggravate pain or other
symptoms.
Try to keep your weight close to ideal.
Stop smoking.
Any doubts concerning vocational and recreational restrictions should
be discussed with your physician and/or physical therapist. They will
be able to suggest safe alternatives to help reduce the risk of further
back problems.