1. osteochondrosis

2. Osteoarthritis is a disease of the joints
Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It should not be confused with rheumatoid arthritis, which is not the same as osteoarthritis. Osteoarthritis is caused by a breakdown of cartilage, the substance that provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint.

3. What Causes Osteoarthritis?
Most cases of osteoarthritis have no known cause. Risk factors include:
Age – osteoarthritis affects more people over the age of 45
Female – osteoarthritis is more common in women than in men
Certain hereditary conditions such as defective cartilage and joint deformity
Joint injuries caused by sports, work-related activity or accidents
Obesity
Diseases that affect the structure and function of cartilage, such as rheumatoid arthritis, hemochromatosis (a metabolic disorder), Paget's disease and gout

4. Signs and Symptoms of Osteoarthritis
Osteoarthritis usually begins slowly. Early in the disease, joints may ache after physical work or exercise. Often the pain of early osteoarthritis fades and then returns over time, especially if the affected joint is overused. Other symptoms may include:
Swelling or tenderness in one or more joints, especially before or during a change in the weather
Loss of flexibility of a joint
Stiffness after getting out of bed
A crunching feeling or sound of bone rubbing on bone
Bony lumps on the joints of the fingers or the base of the thumb
Steady or intermittent pain in a joint (although not everyone with osteoarthritis has pain)
What Is Spondylosis? What Is Spondylosis?
Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the intervertebral discs and facet joints.

5. What Is Spondylosis? What Is Spondylosis?
Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the intervertebral discs and facet joints.

6. Spondylosis often affects the following spinal elements:

7. Intervertebral Discs and Spondylosis
As people age certain biochemical changes occur affecting tissue found throughout the body. In the spine, the structure of the intervertebral discs (anulus fibrosus, lamellae, nucleus pulposus) may be compromised. The anulus fibrosus (e.g. tire-like) is composed of 60 or more concentric bands of collagen fiber termed lamellae. The nucleus pulposus is a gel-like substance inside the intervertebral disc encased by the anulus fibrosus. Collagen fibers form the nucleus along with water, and proteoglycans.
The degenerative effects from aging may weaken the structure of the anulus fibrosus causing the 'tire tread' to wear or tear. The water content of the nucleus decreases with age affecting its ability to rebound following compression (e.g. shock absorbing quality). The structural alterations from degeneration may decrease disc height and increase the risk for disc herniation.
Facet Joints (or Zygapophyseal Joints) and Spondylosis The facet joints are also termed zygapophyseal joints. Each vertebral body has four facet joints that work like hinges. These are the articulating (moving) joints of the spine enabling extension, flexion, and rotation. Like other joints, the bony articulating surfaces are coated with cartilage. Cartilage is a special type of connective tissue that provides a self-lubricating low-friction gliding surface. Facet joint degeneration causes loss of cartilage and formation of osteophytes (e.g. bone spurs). These changes may cause hypertrophy or osteoarthritis, also known as degenerative joint disease.

8. Bones and Ligaments
Osteophytes (e.g. bone spurs) may form adjacent to the end plates, which may compromise blood supply to the vertebra. Further, the end plates may stiffen due to sclerosis; a thickening/hardening of the bone under the end plates.
Ligaments are bands of fibrous tissue connecting spinal structures (e.g. vertebrae) and protect against the extremes of motion (e.g. hyperextension). However, degenerative changes may cause ligaments to lose some of their strength. The ligamentum flavum (a primary spinal ligament) may thicken and/or buckle posteriorly (behind) toward the dura mater (a spinal cord membrane).
Cervical Spine and Spondylosis The complexity of the cervical anatomy and its wide range of motion make this spinal segment susceptible to disorders associated with degenerative change. Neck pain from spondylosis is common. The pain may spread (radiate) into the shoulder or down the arm. When a bone spur (osteophyte) causes nerve root compression, extremity (e.g. arm) weakness may result. In rare cases, bone spurs that form at the front of the cervical spine, may cause difficult swallowing (dysphagia).

9. Thoracic Spine and Spondylosis
Pain associated with degenerative disease is often triggered by forward flexion and hyperextension. In the thoracic spine disc pain may be caused by flexion - facet pain by hyperextension.
Lumbar Spine and Spondylosis Spondylosis often affects the lumbar spine in people over the age of 40. Pain and morning stiffness are common complaints. Usually multiple levels are involved (e.g. more than one vertebrae).
The lumbar spine carries most of the body's weight. Therefore, when degenerative forces compromise its structural integrity, symptoms including pain may accompany activity. Movement stimulates pain fibers in the anulus fibrosus and facet joints. Sitting for prolonged periods of time may cause pain and other symptoms due to pressure on the lumbar vertebrae. Repetitive movements such as lifting and bending (e.g. manual labor) may increase pain.

11. Spondylosis Diagnosis
Neurologic Evaluation A neurologic evaluation assesses the patient's symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.
X-Rays and Other Tests
Any patient experiencing back pain or stiffness in a joint or joints for more than two weeks should see his or her physician for an evaluation. The evaluation usually consists of a discussion of symptoms and a detailed medical history, a physical examination and—if osteoarthritis is suspected—a series of x rays. Other tests (blood tests, MRI or CT scans) may be performed to confirm the presence of spinal arthritis or to rule out other conditions that can cause similar symptoms, such as a tumor, infection, fracture, or other types of arthritis.

12. Diagnosing spinal osteoarthritis Typically, the physician will use a combination of findings from a patient’s medical history, physical exam and medical tests to accurately diagnose whether a patient has osteoarthritis. An accurate diagnosis is very important for guiding the selection of treatment options—and for actually helping relieve the pain and discomfort associated with the patient’s condition.
Physical Examination A thorough physical examination reveals a lot about the health and general fitness of the patient. The exam includes a review of the patient's medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include:
Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm.
Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.

13. Medical history. The patient will be asked to describe his or her symptoms, such as a description of the pain, stiffness and joint function, when and how the symptoms started, and how the symptoms have changed over time. The patient should also discuss how the symptoms affect his or her everyday life and work activities. The doctor also needs to know about the patient’s other medical conditions, current medications, past experience with other treatments, family history, and general lifestyle habits (such as alcohol intake, smoking, etc.). When dealing with pain problems, the doctor is likely to ask key questions related to those things that reliably cause or aggravate the pain and those that reliably bring relief or prevent the pain. Other questions may relate to certain lifestyle topics, such as exercise, nutrition and activities for diversion, sports, etc.
Physical examination. The doctor will conduct a physical exam to assess the patient’s overall general health, musculoskeletal status, nerve function, reflexes and direct evaluation of the problematic joints in the back. The doctor will be looking at muscle strength, flexibility, and the patient’s ability to carry out daily living activities such as walking, bending, and reaching. The patient may also be asked to perform some exercises to test range of motion and determine whether pain worsens during any particular type of movement.

14. X-rays. The doctor will likely order an x-ray to see if there is joint damage and how much joint damage has occurred. The x-ray can show cartilage loss, bone damage, and the presence and location of bone spurs. X-rays are also useful in helping to exclude other causes of pain and to better inform possible considerations about surgery. However, it is important to keep in mind that what shows up in an x-ray may not correlate to the presence or absence of osteoarthritis and associated pain. For example, most people over age 60 have degenerative changes in their spine consistent with osteoarthritis, but for perhaps 85% of them there is no pain or stiffness. Conversely, an x-ray conducted during the early stages of osteoarthritis may not yet show any visible damage to the joints. For all these reasons, the clinical history and physical examination are essential to arriving at an accurate clinical diagnosis and plan of treatment.
Other tests may also be used to rule out conditions other than osteoarthritis that may be causing the patient’s symptoms. For example, blood tests are used to exclude diseases that can cause secondary osteoarthritis or other types of arthritis that simulate osteoarthritis. Joint aspiration, where fluid is drawn from the joints through a needle for examination, can help rule out conditions such as infections or gout.

15. Additional tests that may be needed to rule out other causes of pain or to identify the presence of arthritis with more sophistication than an x-ray can include:
A radioactive bone scan, used to rule out inflammation, a tumor, infection or a small fracture. With a bone scan, the radioactive ‘tracer’ material is injected intravenously and then is concentrated by the body where there is high metabolism or bone turnover. If something suspicious is found on the bone scan, it is usually followed by a CT or MRI scan to distinguish what the bone lesion might represent, since the bone scan alone cannot distinguish among tumors, infections or fractures.
A CT scan may be used to better show the adequacy of the spinal canal and surrounding structures. A CT scan may also include myelography, where an x-ray contrast dye is injected into the spinal column to show structures such as a bulging disc or bone spur possibly pressing on the spinal cord or nerves.
The MRI or magnetic resonance imaging scan, is a very sophisticated imaging method that can show great anatomic details of the spinal cord, nerve roots, discs, ligaments and surrounding tissues and spaces. Most MRI studies require the patient to lie flat in a tube for about 40 minutes, although open frame and even standing MRI scanners exist and seem particularly appropriate for patients having claustrophobia (fear of tight spaces). MRI scans can be adjusted to show different tissues including their water content, important in determining disc degeneration, infections or tumors. The goal of all diagnostic studies is to discover patterns or confirmations between the various tests that point to a clear diagnosis among various possible ones.

16. The key is to diagnose the condition causing the patient’s pain and disability and to guide appropriate treatment, including psychological, physical, medical and/or surgical. Diagnosis is a detective hunt for causes and effects with the goal of improved treatment.
Radiographs (x-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but is not as useful as a CT Scan or MRI.
The CT Scan may be used to reveal the bony changes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities.
Discography seeks to reproduce the patient's symptoms to identify the anatomical source of pain. Facet blocks work in a similar manner. Both are considered controversial.
The physician compares the patient's symptoms to the findings to formulate a diagnosis and treatment plan. Further, the results from the examination provide a baseline from which the physician can monitor and measure the patient's progress.

17. Treatment
Conservative treatment is successful 75% of the time. Some patients may think that because their condition is labeled degenerative they are doomed to end up in a wheel chair some day. This is seldom the case. Many patients find their pain and other symptoms can be effectively treated without surgery.
During the acute phase, anti-inflammatory agents, analgesics, and muscle relaxants may be prescribed for a short period of time. The affected area may be immobilized and/or braced. Soft cervical collars may be used to restrict movement and alleviate pain. Lumbosacral orthotics may decrease the lumbar load by stabilizing the lumbar spine. In physical therapy, heat, electrical stimulation, and other modalities may be incorporated into the treatment plan to control muscle spasm and pain.
Physical Therapy (PT) teaches the patient how to strengthen their paravertebral and abdominal muscles to lend support to the spine. Isometric exercises can be helpful when movement is painful or difficult. Exercise in general helps to build strength, flexibility, and increase range of motion.
Lifestyle modification may be necessary. This may include an occupational change (e.g. from manual labor), losing weight, and quitting smoking.

18. Surgery
Seldom is surgery used to treat spondylosis or spinal osteoarthritis. Conservative forms of treatment are tried first.
If there is neurologic deficit, certain surgical procedures may be considered. However, before surgery is recommended, the patient's age, lifestyle, occupation, and number of vertebral levels involved are carefully evaluated.
A spinal physician is able to determine if surgery is the best treatment for the patient.
Recovery Always follow the instructions provided by the physician and/or physical therapist. This includes:
Take medication as directed. Report side effects to your physician immediately.
Follow the home exercise program provided by the physical therapist.
Avoid heavy lifting and activities that aggravate pain or other symptoms.
Try to keep your weight close to ideal.
Stop smoking.
Any doubts concerning vocational and recreational restrictions should be discussed with your physician and/or physical therapist. They will be able to suggest safe alternatives to help reduce the risk of further back problems.