Osteoarthritis Complete Treatment Guide

While there is currently no proven treatment to stop or slow the progression of osteoarthritis in the spine, there are treatments to alleviate the pain and other associated symptoms, and for most people the condition will not become debilitating. Some patients with osteoarthritis have minimal or no pain, and may not need treatment. Most people who require treatment will benefit from a combination of lifestyle changes such as exercise, weight reduction, and smoking cessation. Most treatment plans for osteoarthritis focus on controlling the pain and improving the patient’s ability to function. Medication is typically used to reduce the inflammation, which in turn reduces the pain and stiffness. In only the most severe cases will surgery be necessary to treat pain and disability from osteoarthritis.

Medical practitioners often refer to osteoarthritis in the spine as spinal arthritis, degenerative joint disease, or arthritis of the facet joints. Spinal arthritis is relatively common and is most likely to occur in people over age fifty. It represents an ongoing, degenerative process in the spine, and may be associated with a number of other degenerative spinal conditions. In particular, osteoarthritis is associated with degenerative discs in the spine. Degenerative discs and osteoarthritis often occur hand in hand because the disc and facet joints (the joints in the back affected by osteoarthritis) are both part of the same three-joint complex. It is thought that degenerating discs can place undue stress on the facet joints, thus over time leading to degeneration and formation of osteoarthritis in the facet joints (also called zygapophyseal joints). This may be why the two degenerative conditions are so often seen together. If the disc as well as the facet joints become painful as a result of degenerative changes in the spine, the condition is often called spondylosis. However, degenerative disc disease and osteoarthritis are different conditions and can occur separately: one can have degenerative discs without any facet osteoarthritis; or one can have facet osteoarthritis without degenerative discs.

Other anatomical markers of disc degeneration that often occur in conjunction with osteoarthritis—and may or may not cause pain or other symptoms—include:

• Synovial cysts. Over time, degeneration of the facet joints in the lower back can result in formation of a fluid-filled sac called a synovial cyst. These cysts are benign in and of themselves, but if they put pressure on the spinal canal they can cause symptoms of spinal stenosis.
• Bone spurs (osteophytes). It is thought (though not proven) that over time the combination of disc degeneration and small amounts of instability can cause bone spurs to form. If the bone spurs impinge on the spinal canal, this can cause pain and symptoms from spinal stenosis. It should be noted that bone spurs are simply radiographic markers of degeneration, and are not in and of themselves painful (unless they pinch a nerve root).

Osteoarthritis of the spine is unlike arthritis of the hip, knee and other joints, as the pain, aches, tiredness and stiffness does not come from just the facet joints but often also from the degenerated discs and inhibition of the spinal extensor muscles. No actual swelling of the facet joint has been demonstrated, but degeneration of the facet joint impacts the many anatomical structures surrounding it in the spine and it is thought that there is an inflammatory component to the condition.

The keys to managing pain and stiffness from osteoarthritis (the degenerating motion segments) are to get an accurate diagnosis of what is the underlying cause of the pain and proactively start treatment.

• Accurate diagnosis. Most people over the age of 40 will have signs of degeneration in the spine; however, not all of these people will have pain or other symptoms. To correctly treat the patient’s pain, it is critical to first identify the actual underlying cause of the patient’s pain. For example, the patient may have a degenerative disc and bone spurs, but it is the osteoarthritis in the facet joints that is causing the patient’s pain on motion. In this case, it would not be necessary to treat the degenerative disc or bone spurs, but rather just to focus on alleviating the pain originating from the arthritic facet joints.
• Proactive treatment. The best proactive treatment to help manage symptoms from osteoarthritis is an active exercise program that emphasizes stretching. Stretching the hip muscles, back joints and hamstrings on a daily basis helps maintain the motion of the spine. Many patients will feel better in an active yoga or pilates program, or other gentle exercise program. Keeping the joints mobile will help them stay healthy.

Spinal arthritis can occur in any part of the spine. This article focuses in particular on osteoarthritis in the low back (lumbar spine), rather than cervical osteoarthritis (arthritis in the neck) or other areas of osteoarthritis.

• Article written By:
• Vert Mooney, MD

May 25, 2005

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