What are the other Names for this Condition? (Also known as/Synonyms)

• Facet Joint Syndrome
• Spinal Osteoarthritis
• Z Joint Arthritis

What is Osteoarthritis of the Spine? (Definition/Background Information)

• Osteoarthritis (OA) is a painful joint disorder characterized by the progressive degeneration of the articular cartilage that covers the bone surface of joints. It is mostly observed in middle-aged and older adults
• Osteoarthritis of the Spine can affect any region from the neck to the lower back, causing pain, discomfort, and stiffness while bending or after prolonged inactivity. The condition may involve the facet joints (or the zygapophyseal joints), the intervertebral fibrocartilage (discs), or the spinal ligaments
• In Spinal Osteoarthritis, the cartilage that cushions the spinal joints gradually wears down, resulting in pain, stiffness, and weakness. This is followed by the formation of bone spurs (abnormal bone growths) at the location. The condition can be debilitating and severely reduce one’s quality of life
• It is generally difficult to diagnose Osteoarthritis of the Spine since the symptoms may be non-specific and include neck pain, shoulder pain, headaches (in some cases), stiff back, and pain in the lower limbs, which may resemble other conditions affecting the spine
• Early and adequate treatment is necessary to control the progression of Osteoarthritis of the Spine. The treatment associated with the condition includes both nonsurgical and surgical methods. The prognosis of Osteoarthritis of the Spine is good with early treatment in a majority of individuals

Who gets Osteoarthritis of the Spine? (Age and Sex Distribution)

• Osteoarthritis of the Spine may occur in individuals of all ages, races, ethnic groups, and belonging to any gender
• Both males and females are affected
• No race or ethnic group preference is observed

What are the Risk Factors for Osteoarthritis of the Spine? (Predisposing Factors)

The risk factors for Osteoarthritis of the Spine may depend on whether the condition is primary (caused by age-related wear and tear of the joint) or secondary (due to an underlying condition or disorder).

The risk factors for primary osteoarthritis may include:

• Advancing age: Osteoarthritis (OA) is rarely diagnosed in individuals under 40 years old. However, since it is a gradually progressing condition, the risk of developing OA usually increases with age
• Individuals with abnormalities involving the spine, such as scoliosis and kyphosis
• Any injury or trauma to the vertebral disc causing its damage is a major risk factor; this may also occur from an underlying condition
• Women are more susceptible to the condition than men, especially after menopause
• Individuals who sustain a joint injury while participating in rough/high-impact sports such as football, tennis, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
• Abnormal pressure on the joints due to excess body weight (obesity)
• Repetitive stress on the joint associated with certain occupations that involve overuse of the spine joints, such as farming or construction-related work, can increase the risk
• Poor posture while sitting, standing, or walking

The risk factors for secondary osteoarthritis may include:

• Prior joint injury or infection 
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Acromegaly
• Hemochromatosis
• Synovial osteochondromatosis (involving the knee or hip)
• Secondary syphilis
• Lyme disease
• Ankylosing spondylitis 
• Psoriatic arthritis
• Avascular necrosis
• Many of the autoinflammatory diseases, such as systemic juvenile idiopathic arthropathy, Behçets disease, and adult-onset Still’s disease
• Gout and pseudogout: Medical conditions caused by high levels of uric acid or calcium crystals in the joint spaces
• Hypermobility syndromes lead to increased range of motion at joints. This excessive mobility leads to increased wear and tear on cartilage and subsequently to early onset secondary osteoarthritis
  • Some conditions are hereditary, such as Ehlers-Danlos syndrome, Marfan syndrome, Stickler syndrome, osteogenesis imperfecta, and others
  • Down’s syndrome, cerebral palsy, and disorders leading to poor muscle tone also lead to increased joint motion
• Wilson’s disease: A copper transport disease with prominent liver and neurologic findings. Wilson’s disease patients also have an increased risk of knee and Spine Osteoarthritis
• Paget’s disease of bone: A rare, chronic bone disorder characterized by abnormal growth and deformity of the bones
• Hypothyroidism: A medical condition characterized by the body’s inability to produce enough thyroid hormone
• Individuals with poorly-controlled diabetes, a chronic medical condition characterized by excessive levels of sugar in blood
• Genetic disorders that cause improper formation of the joints

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Osteoarthritis of the Spine? (Etiology)

Currently, the underlying cause of Osteoarthritis of the Spine is unknown. However, certain causative factors associated with the condition include:

• Any injury to the shoulder joint while participating in sports such as football, tennis, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
• Repetitive stress on the joint from certain occupations
• Obesity, causing abnormal stress on the joints
• Some arthritic disorders have a genetic prevalence: Individuals with an immediate family member or relative having a history of osteoarthritis may also develop this disorder
• Progressive damage of the joint cartilage (due to various reasons) is a key factor
• The cartilage damage of whatever initial cause activates an inflammatory response which leads to further joint destruction

What are the Signs and Symptoms of Osteoarthritis of the Spine?

Osteoarthritis of the Spine is a gradual degenerative disorder that usually worsens over time. The signs and symptoms depend on the location of the condition and may include:

• Pain that may affect anywhere from the neck to the upper, middle, or lower back region
• The pain may radiate along the shoulder and arms; or it may affect the buttocks and thigh
• In some individuals, headaches may be noted quite frequently
• The pain may be intermittent during the initial phase of Spinal Osteoarthritis; the episodes of pain may be mild to intense
• Difficulty in bending or stretching one’s back
• Swelling and tenderness in the affected region
• Stiffness and reduced mobility of the spinal joints
• The pain increases on performing certain activities such as lifting, bending, or while exercising. However, periods of inactivity, followed by sudden simple activity, make the condition even worse
• Muscle spasms
• Growth of bone spurs that may affect or compress the spinal cord or nerve(s)
• If the nerves are affected, it can result in numbness, weakness, or tingling sensation in the leg or arm
• Sometimes, a popping/crunching sound (called crepitus) may be heard on bending backward or arching forward

How is Osteoarthritis of the Spine Diagnosed?

Diagnostic methods that a physician may use to help diagnose Osteoarthritis of the Spine may include:

• Physical examination: The physician will perform a thorough physical examination to determine if the individual has osteoarthritis. In addition to this, a complete medical history may aid in arriving at a diagnosis
• X-ray of the spine: X-rays use radiation in order to produce images of the joint, which can help the physician rule out other possible causes for pain and discomfort
• Various blood tests to rule-out other conditions that may cause similar symptoms
• Joint fluid analysis of affected joint: Occasionally, fluid may accumulate around the shoulder joint. Analysis of this fluid will give clues regarding the cause of the joint fluid accumulation, which causes pain and disability. A needle is inserted into the joint space, and the accumulated fluid aspirated with a syringe. It is then sent to a laboratory for analysis to determine:
  • The type of cells present in the fluid
  • Chemical composition of the fluid
  • The presence of crystals (examination of fluid under a microscope)
• If an infection is suspected as the cause of accumulation of the joint fluid, then a joint fluid culture may be performed. The culture of joint fluid will confirm an infection of the affected joint as the cause of arthritis (termed infective arthritis)
• Ultrasound imaging of the spine: The use of high-frequency sound waves to generate a thorough image of the affected region
• CT, MRI scan of spine

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Osteoarthritis of the Spine?

Osteoarthritis of the Spine is a progressive condition that gradually worsens over time. The complications of the condition may include:

• Chronic pain and stiffness of the neck and back, which may prevent individuals from performing their daily routine activities
• Permanent disability, such as limited motion of or acquired malformation of the spine
• Decreased quality of life

How is Osteoarthritis of the Spine Treated?

The treatment of Osteoarthritis of the Spine includes nonsurgical and surgical methods. A healthcare provider may start with non-surgical treatment methods before adopting surgical procedures and techniques. These include:

• Rest: Any activity that aggravates the back further should be avoided. The physician usually advises to refrain from all such activities until the symptoms get better
• Heat and ice: Applying a damp heated towel or ice to the joint can help reduce pain and swelling
• Splint or brace: A physician may prescribe some type of padded splint or cast to help keep the joint in a stable position, especially while sleeping
• Use of topical analgesic creams and muscle relaxants
• Non-steroidal anti-inflammatory medication: Medications, such as ibuprofen and naproxen, can help decrease the joint pain and swelling
• Topical non-steroidal medications have been shown to improve osteoarthritis at specific locations. Application twice a day is required for a month, then daily, to attain relief
• Corticosteroid medications, such as prednisone, help provide temporary relief of symptoms and improve the range of motion within the joint.  Corticosteroids can be given systemically or injected directly into a specific affected joint It is important to note that corticosteroid injections may only give temporary relief. Repetition of such injections can ultimately lead to further joint injury
• Transcutaneous electrical nerve stimulation (TENS): TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on the skin
• Physical therapy: After the symptoms have decreased, it is important to begin some light motion exercises (shoulder joint exercises). Physical therapy may help restore strength, as well as provide flexibility to the muscles

Surgical treatment measures include:

• Vertebral or spinal fusion: Vertebral fusion is a surgical technique that involves the removal of the arthritic part within the joint and fusing two surrounding bones together. The purpose of this procedure is to relieve pain, stabilize the joint, and regain some range of motion in the affected joint
• Decompressive laminectomy: This is a surgical procedure intended to relieve pressure on the spinal cord and/or nerves by removing the lamina in order to widen the spinal cord. During a laminectomy procedure, the lamina (the small section of the bony roof in the spine) is removed to create additional space for the surrounding nerves within the spinal canal. A bone graft material then fills the empty space, and two or more vertebrae of the spine are fused together to create stability. However, this procedure may also be performed without a spinal fusion, or the healthcare provider may elect to perform a discectomy (removing of part the disc)

How can Osteoarthritis of the Spine be Prevented?

A few recommendations to help prevent Osteoarthritis of the Spine include:

• Individuals who maintain a healthy diet may decrease the chance of developing this condition. Some evidence exists that adherence to the Mediterranean diet leads to improvement in osteoarthritis
• Estrogen replacement therapy can decrease the incidence of osteoarthritis after menopause in women
• Using correct posture and tools that decrease stress on joints in the workplace can decrease the incidence of the condition due to occupational causes
• Undertake a proper treatment of gout or pseudogout
• Prompt and adequate treatment of individuals with Paget’s disease
• In individuals with hypothyroidism, prompt treatment of the thyroidal condition is necessary
• Proper treatment of diabetes
• Maintaining a healthy body weight can help prevent/avoid abnormal pressure on the joints
• Individuals who participate in any high-risk sports, such as football and basketball, should wear appropriate safety gear to help prevent serious injuries to their joints

What is the Prognosis of Osteoarthritis of the Spine? (Outcomes/Resolutions)

The long-term prognosis of Osteoarthritis of the Spine depends on the severity of this degenerative condition.

• If osteoarthritis is detected early and proper aggressive treatment is provided, then the prognosis is good in a majority of individuals if no serious complications are noted
• In general, without treatment, a high percentage of individuals who develop this condition may experience a lifetime of gradual degeneration that can be debilitating

Additional and Relevant Useful Information for Osteoarthritis of the Spine:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/