Brief overview
- Causes and risk factors: Age-related wear and tear; overuse from sports, heavy physical labor, or obesity increase risk
- Symptoms: Back pain that cannot be localized precisely, often worse during the day and with exertion; morning stiffness of the spine, possible radiation to legs or neck
- Diagnosis: Medical history, physical examination, possibly X-ray, magnetic resonance or computer tomography (MRI or CT)
- Treatment: Painkillers, physiotherapy, back training. Under certain circumstances, sclerotherapy of the nerves or surgery.
- Prognosis: Sustained therapy often relieves symptoms, especially pain; rarely, pain remains chronic
- Prevention: Balanced regular exercise prevents back problems to some extent; gentle work techniques may avoid occupational diseases
What is spondyloarthritis?
The small vertebral joints (facet joints) wear out and lose their natural structure. Spondyloarthritis is therefore also called facet syndrome. In most cases, there is no specific trigger for spondyloarthritis: the vertebral joints “age” due to the permanent natural stress.
One speaks of activated spondyloarthritis when an inflammation (arthritis) is added to the wear and tear of the joints.
Frequency
Degenerative changes such as spondyloarthritis are practically inevitable as one grows older. Already at the age of 40, every second inhabitant in Germany is affected. At the age of 60, X-rays show signs of old age in the spine in about 90 percent of people. However, not every person with a conspicuous X-ray suffers from complaints.
Spondylarthrosis combined with other signs of aging
In principle, every element of the musculoskeletal system ages. In most cases, several elements are also involved in the arthrosis of the back. The most serious problem gives the disease its name. Thus, in addition to spondyloarthritis, there are chondrosis, osteo-chondrosis and spondylosis. These different forms of degenerative change in the spine can usually not be clearly separated from each other. In the case of an “osteoarthritic spine”, they often merge into one another and are mutually dependent.
Chondrosis: If the intervertebral discs lose some of their fluid, they are less elastic. The spine becomes more unstable. As a result, the intervertebral discs are put under more stress every time they are shaken. They develop cracks and gaps and are then later often eventually completely destroyed. This so-called chondrosis intervertebralis contributes a part to the “arthrosis back”.
Spondylosis: To compensate for reduced spinal stability, bony prominences form on the outside of the vertebrae (spondylophytes). This is what doctors call spondylosis. Spondylophytes sometimes completely bridge the gap between two adjacent vertebrae. Often, this causes the spine to deform and stiffen (spondylosis deformans).
Where can spondyloarthritis occur?
Spondyloarthrosis is possible in the entire spinal column. A distinction is made between the most commonly affected area of the lumbar spine (LWS), the area of the cervical spine (HWS) and that of the thoracic spine (BWS). Accordingly, one speaks of lumbar (lumbar spine), cervical (cervical spine) or thoracic (thoracic spine) spondylarthrosis (or facet syndrome).
Wear and tear of the vertebral joints is possible not only at one point (one segment) of the spine, but also at several at the same time (multisegmental spondyloarthritis).
It is not possible to say in general terms whether or for how long a person with spondyloarthritis will be unable to work or even severely disabled. This depends on the individual case, the severity of the symptoms and the respective occupational activity.
Under certain conditions – especially in the case of heavy physical work – recognition as an occupational disease is possible. Under certain circumstances, certain occupational activities may then not be possible in the usual form.
With appropriate treatment, a degree of disability (GdB) – i.e. a severe disability – does not usually have to be recognized. This is only necessary in individual cases and very rarely if spondyloarthritis persists chronically with persistent pain.
Causes and risk factors
Many older people develop spondyloarthritis at some point because their vertebral joints wear out over time. There are also other causes of spondyloarthritis.
It occurs, for example, when the spine is subjected to heavy loads, such as in certain sports or professions. Hairdressers or kindergarten teachers sometimes suffer from spondyloarthritis in the cervical spine because they often have to lower their heads. Excess weight, in turn, puts particular strain on the lumbar spine.
Scoliosis, a hollow back (lumbar hyperlordosis), a herniated disc and rheumatic diseases are other possible causes.
Symptoms
The vertebral joints are in close proximity to nerves that run in the spinal canal inside the spine. If the spinal canal is narrowed by spondyloarthrosis, symptoms are possible.
Those affected often also experience an unpleasant tingling sensation. These complaints usually disappear over time or if the patient does not move. In extreme cases, it is possible that nerve damage caused by spondyloarthritis may even lead to paralysis.
In addition, spondyloarthritis often makes the spine more immobile. Affected individuals have difficulty bending over or leaning to one side. Usually, the lumbar spine (LS) is most affected by osteoarthritis. The cervical spine (HWS) and thoracic spine (BWS) have to withstand less stress and therefore do not develop spondylarthrosis as quickly.
Osteoarthritis of the cervical spine often results in neck pain that also occasionally radiates to the arms.
Read more about the general symptoms of osteoarthritis in the article Osteoarthritis Symptoms.
Diagnosis
Read more about the diagnosis of joint wear and tear in the article Arthrosis.
Treatment
The doctor usually treats spondyloarthritis conservatively at first, for example with medications (painkillers, muscle relaxants), occupational therapy and physical therapy. Manual therapies such as trigger point treatment also often relieve the symptoms.
In addition, injections containing analgesics help. This often involves a local anesthetic, combined with “cortisone” if necessary.
In cases of persistent pain, doctors also resort to procedures that switch off the nerves that are responsible for the sensation of pain. For this purpose, they use radio waves, for example. The heat generated causes the nerves to perish. This so-called radiofrequency therapy (also radiofrequency neurotomy) is scientifically the best studied.
You can read more about conservative therapy for joint wear and tear in the article on osteoarthritis.
Decompression
During a laminectomy, the doctor removes individual pieces of bone from the vertebra. This is important when bony structures constrict the spinal canal and openings through which nerves pass. Pinched nerves are relieved in this way.
Interventions without fusion
To stabilize an unstable spine, it is possible for the physician to insert so-called pedicle screws into several vertebrae. This is especially useful when patients have pain when moving. The screws have a special attachment and can be connected to each other via a rod. In this way, they bring the vertebrae into the correct position. To ensure that the vertebral joints still remain mobile, the doctor uses a movable rod. In this way, he stabilizes the spine but does not restrict its function.
Vertebral body fusion
In addition, a destroyed intervertebral disc can be replaced with a so-called cage. This is a small basket made of metal, plastic or ceramic. In some cases, the doctor also “builds” the body’s own bone material into the spine. Over time, it grows into the vertebrae and firmly connects them together.
The spine stabilizes in the operated areas and pinched nerves regain more space. However, these treatments also make the spine stiff. They are therefore usually only considered in cases of advanced spondyloarthritis.
Course of the disease and prognosis
In the case of spondyloarthritis, sustained pain relief can often be achieved through consistent therapy. This and a good quality of life are the main goals of treatment.
To achieve this, it is particularly important to build up the stabilizing musculature. Physio-therapy offers instructions for self-help in this regard.
Prevention
Age-related wear and tear can only be prevented to a certain extent. It is helpful, for example, to avoid excess weight and one-sided stress.
Regular, balanced exercise that strengthens the back is a good way to prevent spondylarthrosis and many other back disorders.
Those who use techniques and aids that relieve strain and are easy on the joints when carrying heavy loads and doing heavy physical work often prevent occupational illness and loss of working hours.