Spondylosis (Spinal Osteoarthritis)

What spondylosis means

"Spondylosis" comes from the Greek spondylos, meaning vertebra. It is a descriptive term for age-related spinal wear rather than a single disease. The changes include:

• disc degeneration: discs lose water and height and may bulge (degenerative disc disease)
• facet joint osteoarthritis: cartilage thins and joints enlarge
• bone spurs (osteophytes): bony growths along the vertebrae
• ligament thickening

For a broader overview of how the whole spine changes with age, see age-related spinal changes.

Spondylosis vs similar-sounding terms

Cervical spondylosis (neck)

Cervical spondylosis is extremely common after 50. Most people have no symptoms or intermittent neck stiffness.

Symptoms

• neck pain and stiffness, often worse after holding the head in one position
• headaches starting at the back of the head
• grinding or clicking when turning the neck

Cervical radiculopathy

A bone spur or disc presses on a nerve root, causing:

• sharp or burning pain radiating into the shoulder, arm or hand
• tingling or numbness in specific fingers
• weakness of specific arm muscles

See cervical radiculopathy.

Cervical myelopathy

Narrowing of the spinal canal compresses the spinal cord itself:

• clumsy, numb hands; difficulty with buttons or handwriting
• unsteady walking and balance problems
• electric shock sensations down the spine when bending the neck
• in advanced cases, bladder problems

Myelopathy tends to progress and often needs surgery.

Lumbar spondylosis (lower back)

Symptoms

• low back pain and stiffness, often worse after rest and with prolonged standing
• sciatica: pain, numbness or tingling running down the leg, from nerve root compression
• neurogenic claudication: leg pain, heaviness or weakness when walking or standing, relieved by sitting or bending forward. This is typical of lumbar spinal stenosis

Risk factors

• age (the main factor)
• genetics
• previous neck or back injury
• occupations with repetitive neck movements, heavy lifting or vibration
• smoking
• excess weight (lumbar)

Diagnosis

• history and examination: range of movement, strength, reflexes, sensation, gait, and signs of myelopathy (such as brisk reflexes or Hoffmann's sign)
• X-rays: disc narrowing, bone spurs, alignment and instability on flexion-extension views
• MRI: the best test for nerve root and spinal cord compression
• CT or CT myelogram if MRI is not possible
• nerve conduction studies and EMG to confirm nerve damage

Because spondylosis is so common on imaging, doctors focus on whether the findings match your symptoms.

Treatment

Non-surgical

• stay active; avoid prolonged bed rest
• physical therapy: strengthening, stretching, posture correction
• pain relief: NSAIDs (following the label dose, and with caution if you have kidney, stomach or heart problems), acetaminophen (paracetamol), topical anti-inflammatories
• heat and massage
• nerve pain medicines such as gabapentin or duloxetine for radiating pain
• short-term soft collar for acute neck flares only
• epidural steroid injections for radiculopathy that does not settle

Most people with radiculopathy improve within weeks to months without surgery.

Surgery

Considered for:

• progressive myelopathy
• progressive weakness
• severe, persistent radicular pain despite good non-surgical care
• disabling neurogenic claudication

Procedures include anterior cervical discectomy and fusion (ACDF), cervical disc replacement, laminoplasty or laminectomy for myelopathy, and lumbar decompression with or without fusion.

Frequently asked questions

What does spondylosis mean?

Spondylosis means age-related wear and tear of the spine, including disc degeneration, facet joint arthritis and bone spurs. It is very common after 50 and often causes no symptoms.

What are the symptoms of cervical spondylosis?

Typical symptoms are neck pain and stiffness and headaches at the back of the head. If nerves are pinched, pain, numbness or weakness can spread into the arm. If the spinal cord is compressed, hands become clumsy and walking unsteady.

What is the difference between spondylosis and spondylitis?

Spondylosis is degenerative, wear-and-tear arthritis of the spine, usually in older adults. Spondylitis is inflammatory arthritis, such as ankylosing spondylitis, which typically starts before 45, causes long morning stiffness and improves with exercise.

Can spondylosis be cured?

The structural changes cannot be reversed, but symptoms usually improve with exercise, physical therapy and pain management. Surgery can relieve nerve or spinal cord compression when needed.