Cervical, Lumbar and Thoracic Arthritis of the Spine
Arthritis is a general term that describes many different diseases causing the following symptoms: tenderness, pain, swelling, and stiffness of joints as well as abnormalities of various soft tissues of the body. The term arthritis means “inflammation of the joints”. Various forms of arthritis affect close to 50 million Americans and contribute to the majority of all physical disabilities.
Arthritis affects approximately 80% of people over the age of 55 in the United States. It is estimated that by the year 2020, over 60 million people will suffer from this often-disabling problem.
Arthritis can affect any part of the body, including the spine. There are many forms of arthritis but the most common and most painful is osteoarthritis. Osteo- (meaning bone) arthritis mostly affects the weight bearing joints (hips and knees) plus the hands, feet and spine.
Normal joints are covered by cartilage and are lubricated by a closed sack by the synovial fluid. Normal joints have remarkably little friction and move easily. With degeneration of the joint, the cartilage becomes rough and worn out, causing the joint halves to rub against each other, creating inflammation with pain and the formation of bone spurs. The fluid lubricant may become thin and the joint lining swollen and inflamed.
Osteoarthritis is also sometimes confused or may be associated with degenerative disc disease, a gradual deterioration of the disc(s) between the vertebrae of the spine. This is because osteoarthritis and degenerated discs are commonly found together even though they are separate conditions.
Osteoarthritis affects up to 30 million Americans, mostly women and usually those over 45 or 50 years of age. All races in the U.S. appear to be equally affected.
Another type of spinal arthritis occurs in the facet joints. The facet joints are located in the posterior aspect of the spine and connect the two vertebrae together. The facet joints can commonly develop thickening and hardening with age, which can lead to arthritis. Arthritis in the facet joints can cause slight to severe pain, sometimes radiating into the buttocks or upper thighs.
Spinal arthritis is certainly one of the common causes of back pain which breaks down the cartilage between the aligning facet joints in the back portion of the spine and quite often leads to pain. The facet joints (also called vertebral joints) become inflamed and progressive joint degeneration creates more frictional pain. This causes a decrease in back motion and flexibility. Often standing, sitting or even walking will cause back pain. Over time, bone spurs (small irregular growths on the bone also called osteophytes) typically form on the facet joints and even around the spinal vertebrae. These bone spurs are a response to joint instability and are nature's attempt to help return stability to the joint. The enlargement of the normal bony structure indicates degeneration of the spine. Bone spurs are also seen as a normal part of aging and do not directly cause pain, but may become so large as to cause irritation or entrapment of nerves passing through spinal structures, and may result in diminished room for the nerves to pass developing into a condition known as spinal stenosis.
Causes of Arthritis of the Spine
Arthritis occurs when the cartilage in the joints is worn down as a result of wear and tear, aging, injury or misuse.
Osteoarthritis, the most common form of arthritis, also includes loss of cartilage, overgrowth of bone and the formation of bone spurs. This causes the bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint. Osteoarthritis can occur in any joint but most often occurs in the hips, knees, hands or the spine.
Osteoarthritis in the spine is anatomically divided into 2 sections of the spine:
- Lumbar Spine (lower back) osteoarthritis, sometimes called lumbosacral arthritis, which produces stiffness and pain in the lower spine and sacroiliac joint (between the spine and pelvis)
- Cervical Spine (neck) osteoarthritis, sometimes called cervical spondylosis (spondy- implies the spine, and -osis is an abnormal condition), which can cause stiffness and pain in the upper spine, neck, shoulders, arms and head.
Osteoarthritis usually develops over a period of time.
Symptoms in the Early Stages of Osteoarthritis:
- Patient experiences joint aches after physical work or exercise, which fades and then returns as the affected joint is used or overused
- As cartilage between the bones gets thinner, pain becomes steadier
- Patient experiences pain difficulty walking or climbing stairs
- Joint pain and stiffness occurs after long periods of inactivity, such as sitting in the car for a long drive or watching a 2-hour movie
Symptoms in the Advanced Stages of Osteoarthritis:
- Pain is substantial and constant, even at rest or with very little movement
- With progress osteoarthritis, a single joint may at first be affected, but with time and further activities, many joint of the body may be affected , including the base of the neck, knees, hips, hands and/or feet.
Osteoarthritis differs from systemic forms of arthritis because it only affects joints (although it may lead to an entrapment of a nerve at any level in the spine or the spinal cord in the neck) and does not affect organs or soft tissue areas of the body.
The following are some causes that contribute to the development of arthritis:
- Aging: steady and advanced aging of spinal structures, often is work related
- Gender: osteoarthritis being more common in post-menopausal women (although below age 45, it is more common in males)
- Excess weight: causing more stress on weight-bearing joints and the spine
- Genetics: having a family history of osteoarthritis or congenital defects of joints, spine, or leg abnormalities
- Associated diseases: the presence of other associated diseases, infections, diabetes, and various other forms of circulating arthritis, such as rheumatoid arthritis or gout
- Overused joints from work or sports related activities
Symptoms of Arthritis of the Spine
Generally, the signs and symptoms of arthritis include inflammation, stiffness and pain in the joints. In the spine, symptoms may also include one or more of the following:
- Back pain that comes and goes
- Spinal stiffness in the morning such as after getting out of bed or after activity. Often this pain decreases with rest or, for some, after exercise
- Pain, tenderness or numbness in the neck, if nerve impingement is involved
- Lower back pain that runs down into the buttocks, thighs, or pelvic area
- Pain or tenderness in the shoulders, hips, knees or heels
- A crunching feeling or sound of bone rubbing on bone
- Weakness or numbness in legs or arms
- Limited range of motion, difficulty bending or walking
- Spinal deformity
Osteoarthritis is characterized primarily by stiffness and pain in the joints, although not everyone with osteoarthritis actually experiences pain and disability. The stiffness and pain tend to be worse in the morning and again in the evening, with improvement during the day as the person carries on his or her daily activities. Pain that awakens one during the night is often an indicator.
Osteoarthritis pain in the lumbar region (lower back) can stem from nerve irritation from a herniated disc or from bone spurs and can cause weakness, numbness, tingling and/or pain in the legs that often radiates to one foot. Arthritis causing spinal stenosis or narrowing of the spinal canal in the lower back can cause pain and walking difficulty in both legs.
Osteoarthritis pain in the cervical region (neck) again tends to be worse in the morning and evening, with improvement during the day. This pain often radiates to the shoulder, between the shoulder blades and up the neck to cause headaches. With nerve impingement or a herniated disc, there may also be weakness or numbness of one hand, certain fingers or sometimes even in both arms.
Compression of the spinal cord in the neck can even cause problems with walking as well as in bowel and bladder control in severe cases.
Other symptoms of arthritis in the spine can include:
- Swelling and warmth in one or more joints, particularly during weather changes (which may be related to barometric pressure changes and cooling of the air)
- Localized tenderness when the joint or affected area of the spine is pressed
- Steady or intermittent pain in a joint, which is often described as an aching type of pain
- Loss of flexibility of a joint, such as inability to bend and pick something off the floor
- A crunching feeling or sound of bone rubbing on bone when the joint is moved, particularly notable in the neck
- An abnormal curve in the spine which may be due to unbalanced muscle spasm
- A sensation of pinching, tingling or numbness in a nerve or the spinal cord, which can occur when bone spurs form at the edge of the joints of the spine and irritate the nerves
The chronic pain associated with arthritis can very seriously affect your quality of life. If left untreated, it can also lead to physiological problems such as muscle breakdown or weakness as well as psychological difficulties such as anxiety and depression.
Treatment of Arthritis of the Spine
You don't have to live with the chronic pain of arthritis. Dr. Emmanuel and his staff of trained medical professionals offer advanced, minimally invasive, outpatient surgical procedures that can relieve the symptoms of the pain of arthritis in the spine. No hospital stays, no general anesthesia, no lengthy recuperation time, immediate relief of painful symptoms. The treatment Dr. Emmanuel offers depends on the specific conditions and symptoms caused by arthritis. Percutaneous Discectomy, Laminotomy, and Foraminotomy are some of the procedures Dr. Emmanuel uses to correct the symptoms caused by arthritis of the spine. For arthritis of the facet joints, Dr. Emmanuel utilizes a laser procedure called Facet Thermal Ablation.