What is Spondylosis?

Spondylosis is a medical term for degenerative arthritis or wear-related change in the spine. It may involve the intervertebral discs, facet joints, vertebrae, ligaments, and bone spurs, also called osteophytes.

Spondylosis can occur in the cervical spine in the neck, thoracic spine in the mid back, or lumbar spine in the lower back. Some people have spondylosis on X-rays, CT, or MRI without major symptoms. Others may develop neck pain, back pain, stiffness, radiculopathy, spinal stenosis, myelopathy, or symptoms related to nerve or spinal cord compression.

De Novo Brain & Spine evaluates adult patients with spondylosis when symptoms suggest cervical radiculopathy, lumbar radiculopathy, spinal stenosis, spinal instability, degenerative disc disease, facet joint disease, spinal cord compression, or persistent spine-related pain that may require neurosurgical review.

Common Signs and Symptoms

Spondylosis symptoms depend on the spinal region involved, the severity of degenerative change, and whether nearby nerves or the spinal cord are affected.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Spine stiffness or reduced range of motion
• Pain that worsens with certain movements, prolonged standing, sitting, bending, lifting, or twisting
• Muscle tightness or spasms
• Pain that travels into the shoulder, arm, hand, buttock, leg, or foot when nerve compression is present
• Numbness or tingling in the arms, hands, legs, or feet
• Weakness in the arms, hands, legs, ankles, or feet
• Sciatica or lumbar radiculopathy when lower back nerves are affected
• Cervical radiculopathy when neck nerves are affected
• Neurogenic claudication, meaning leg pain, heaviness, cramping, or weakness that worsens with standing or walking
• Balance problems, trouble walking, or loss of hand coordination when cervical spinal cord compression is present
• Reduced grip strength or difficulty with fine hand movements in selected cervical cases
• Pain that overlaps with degenerative disc disease, facet joint disease, spinal stenosis, or spondylolisthesis

Seek urgent medical evaluation for progressive weakness, foot drop, worsening numbness, balance problems, trouble walking, loss of hand coordination, numbness in the groin or saddle area, new bowel or bladder problems, severe pain after trauma, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

Spondylosis usually develops from gradual degenerative changes in the spine. These changes can affect the discs, joints, bones, ligaments, and spaces where nerves travel.

Possible causes and related factors may include:

• Age-related wear of the spine
• Degenerative disc disease, with disc dehydration or loss of disc height
• Facet joint disease or arthritis of the small joints in the back of the spine
• Bone spurs, also called osteophytes
• Thickening of spinal ligaments in selected cases
• Repetitive bending, lifting, twisting, or spine stress
• Prior spine injury or trauma
• Prior spine surgery in selected patients
• Genetic or family tendency toward degenerative spine change
• Smoking, which may affect disc and bone health in some patients
• Excess body weight, which may increase stress on spinal structures
• Spinal alignment problems, such as scoliosis, kyphosis, or spondylolisthesis
• Associated spine conditions such as spinal stenosis, foraminal stenosis, herniated disc, bulging disc, or spinal instability

These causes and risk factors do not mean every patient with spondylosis will have pain. Spondylosis can appear on imaging in people without symptoms, so treatment planning depends on the patient’s symptoms, examination, imaging findings, neurological function, and overall health.

How It Is Diagnosed?

Spondylosis is diagnosed by combining the patient’s symptoms, physical examination, neurological examination, and imaging findings. Imaging is helpful, but degenerative changes must be matched with the patient’s symptoms and exam.

Common diagnostic steps may include:

• Medical history and symptom review to understand neck pain, back pain, arm pain, leg pain, stiffness, numbness, tingling, weakness, walking tolerance, injury history, and prior treatment
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, spinal alignment, gait, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, balance, walking, hand function, and signs of nerve root or spinal cord involvement
• X-rays of the spine to evaluate alignment, disc space narrowing, bone spurs, arthritis, spondylolisthesis, fracture, or degenerative change
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is suspected
• MRI of the cervical, thoracic, or lumbar spine to evaluate disc disease, spinal stenosis, foraminal stenosis, nerve root compression, spinal cord compression, tumor, infection, or other soft-tissue findings
• CT scan when bone detail, bone spurs, fracture, arthritis, deformity, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with radiculopathy, carpal tunnel syndrome, ulnar neuropathy, peripheral neuropathy, or peroneal neuropathy
• Blood tests in selected cases when infection, inflammatory arthritis, cancer-related concern, or another medical condition is suspected
• Diagnostic injections in selected cases when symptoms may overlap with facet joint disease, sacroiliac joint pain, or nerve root irritation

The goal of diagnosis is to determine whether spondylosis is causing symptoms, identify whether nerve or spinal cord compression is present, and decide whether conservative care, injections, or surgical evaluation may be appropriate.

Treatment Options

Spondylosis treatment depends on the spinal region involved, symptom severity, neurological examination, imaging findings, spinal stability, nerve or spinal cord involvement, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, cauda equina syndrome, severe spinal cord compression, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Observation and symptom monitoring when spondylosis is found incidentally and is not causing symptoms
• Activity modification to reduce positions, lifting, bending, twisting, or movements that worsen symptoms
• Physical therapy to improve posture, mobility, flexibility, strength, walking mechanics, and spine stability
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Treatment of posture, ergonomic, conditioning, or activity-related contributors
• Cervical or lumbar epidural steroid injection in selected cases involving nerve root inflammation or radiating arm or leg pain
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Facet joint injection, medial branch block, or radiofrequency ablation in selected cases when facet joint pain contributes to symptoms
• Lumbar decompression, such as laminectomy, laminotomy, or foraminotomy, in selected cases involving spinal stenosis or nerve root compression
• Cervical decompression, such as cervical laminectomy or posterior cervical decompression, in selected cases involving cervical stenosis or spinal cord compression
• Anterior cervical discectomy and fusion, also called ACDF, in selected cervical cases involving disc-related stenosis, nerve compression, spinal cord compression, or instability
• Cervical disc replacement in selected patients with appropriate anatomy and disc-related nerve compression
• Lumbar fusion, such as transforaminal lumbar interbody fusion, lateral interbody fusion, or anterior lumbar interbody fusion, in selected cases involving instability, deformity, spondylolisthesis, or certain recurrent spine conditions
• Cervical posterior fusion when stabilization is needed for instability, deformity, trauma, or selected degenerative conditions
• Rehabilitation and follow-up care to monitor pain, strength, sensation, walking, balance, function, and neurological status

Surgery is not appropriate for every patient with spondylosis. Neurosurgical treatment may be considered when spondylosis is associated with significant nerve compression, spinal cord compression, spinal stenosis, progressive weakness, myelopathy, spinal instability, deformity, or symptoms that do not improve with appropriate non-surgical care.