SPONDYLOSISKhairul Nizam Abdul Rahman4262143008BPY 1Madam Farah

INTRODUCTION• Spondylosis (spinal osteoarthritis) is a degenerative

disorder. • It is the general wear and tear that occurs in the joints and

bones of the spine as people get older.• More than 85% of people over age 60 are affected.• Spondylosis may affect the cervical (neck), thoracic (mid-

back), or lumbar (low back) regions of the spine.• It may cause loss of normal spinal shape and function.• Although aging is the primary cause, the location and rate

of change is different from person to person.

PATHOPHYSIOLOGY• When we get older the disk, fragment, lose water content and collapse. • This starts in the nucleus pulposes (the inner part of the IVD), the water

content will decrease and will buckling inward, the annulus fibrosis (the outer part of the IVD) will become thinner and bulge outward.

• When the IVD become thinner it will increase the mechanical stress at the cartilaginous end plates at the vertebral body lip.

• The cartilage that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone.

• To make up for the lost cartilage, our body may respond by growing new bone in the facet joints to help support the vertebrae.

• Over time, this bone overgrowth called spurs may narrow the space for the nerves to pass through (stenosis). Some cases, encroach on nervous tissue.

• In addition, hypertrophy of the uncinate process occurs, often encroaching on the ventrolateral portion of the intervertebral foramina. It can "pinch" or compress those nerves.

TYPESCervical (neck) Spondylosis• The complex anatomy and large movements in the neck make this area

of the body susceptible to degenerative change. Neck pain from spondylosis is common. The pain may spread into the shoulder or down the arm.

Thoracic (mid-back) Spondylosis• The thoracic spine is less commonly affected due to its reduced

movement. If there is spondylosis in this region the shape of the mid back can round to the appearance of a hunchback, this is called a kyphosis.

Lumbar (low back) Spondylosis• Spondylosis often affects the lumbar spine in people over the age of 40.

Pain and morning stiffness are common complaints. Usually many levels are involved. The lumbar spine carries most of the body's weight. Therefore, when degenerative changes affect its structure you may get pain with activity such as walking and standing, lifting objects or after long periods of rest.

CAUSES• Aging : When we get older, the discs dehydrate, become thinner

and become harder. They then provide less support to the vertebrae resting on the discs.

• Repetitive strain injury (RSI) caused due to lifestyle without ergonomic care, e.g., while working in front of computers, driving, traveling, intense work in farm, etc.

• Risk factors: Genetics – If family has a history of neck pain• Smoking: Clearly linked to increased neck pain• Occupation: Jobs with lots of neck motion and overhead work• Mental health issues : Depression/Anxiety• Injuries/trauma: Car wreck or on-the-job injury

SYMPTOMS• Joint pain.• Tenderness • Swelling.• Muscle spasms.• Limited ROM.

SURGICAL MANAGEMENT• Laminectomy: is a procedure to remove the bony arches

of the spinal canal decreasing pressure on the spinal cord.• Discectomy: is a procedure to remove a portion of an

intervertebral disc that is putting pressure on a nerve root or the spinal canal.• Foraminectomy: is a procedure to expand the openings

for the nerve roots to exit the spinal canal. • Fusion: fusion of the vertebrae is sometimes combined

with one or more of these procedures in order to stabilize the spine.

PHARMACOLOGY MANAGEMENT• Acetaminophen: Tylenol is an example of an

acetaminophen, a type of medication that has proven to be a good pain reliever. Acetaminophen works by essentially blocking the brain's perception of pain, and it's good for pain flare-ups that may come with spondylosis.• Muscle relaxants: Because of the anatomical changes to

the spine from spondylosis, muscles may have to work harder to support the spine. Sometimes, the muscles can have spasms as they become overworked. So muscle relaxant, will help to stop the spasms. Valium is an example of a muscle relaxant.

PHYSIOTHERAPY MANAGEMENTHeat Therapy• Improves blood circulation, decreases nerve and muscle inflammation and it

relieves muscle spasm

Cold Therapy • Decreases inflammation, relieves muscle spasm and it reduces nerve

irritation by reducing nerve edema.

Soft Collars (neck immobilization)• Immobilization limits the motion of the neck, thereby reducing the nerve

irritation. It allow the muscles of the neck to rest. Soft collars should only be worn for short periods of time because long-term can decrease the strength of neck muscles.

PHYSIOTHERAPY MANAGEMENTElectrical stimulation• TENS - can be issued to a patient for home use. Stimulates the

muscles through variable intensities of electrical current. It helps reduce muscle spasms and pain. It may also drive out inflammation, bring in healing properties, relax, and re-educate the muscles involved.

• SWD - Relieves muscle spasm and causes muscle relaxation, reduces inflammation and it improves blood circulation

Traction• This form of treatment may be useful for spondylosis because it

promotes immobilization of the cervical region and widens the foraminal openings. 

PHYSIOTHERAPY MANAGEMENTManual therapy• Such as mobilization and manipulation, may provide

further relief for patients with cervical spondylosis. Mobilization is characterized by the application of gentle pressure within or at the limits of normal motion, with the goal of increasing the ROM. Manipulation is characterized by a high-velocity thrust, which is often delivered at or near the limit of the ROM. The intention is to increase articular mobility or to realign the spine.

PHYSIOTHERAPY MANAGEMENT

EVIDENCE• Mobilisation, manipulation, and exercise seem to be equally

effective. A study comparing combined exercise and manipulation with either modality alone found the combination to be more effective at three months, but no difference was seen compared with exercise alone at one and two years. However, another pragmatic study found no advantage at six weeks or six months of adding manual therapy (63% of patients had mobilisation physiotherapy) or heat (shortwave diathermy) to exercise and advice.

• G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H Spine (Phila Pa 1976). 2001 Apr 1

EVIDENCE• Randomised controlled trials identified by systematic

reviews provide moderate evidence that various exercise regimens—using proprioceptive, strengthening, endurance, or coordination exercises—are more effective than usual care (analgesics, non-steroidal anti-inflammatory drugs, or muscle relaxants) or stress management, although not all studies have found exercise beneficial. One randomised controlled trial found exercise plus infrared heat no more effective than transcutaneous electrical nerve stimulation plus heat at relieving pain at six weeks and six months, although both were better than heat alone.

• Sarig-Bahat H Man Ther. 2003 Feb 8