Causes, Symptoms, and Treatments of Spinal Osteoarthritis
Approximately 30 million Americans (including myself) suffer with osteoarthritis, most of whom are women and people over the age of 45. The term osteoarthritis comes from the Greek osteo meaning “of the bone,” combined with the term arthritis; arth meaning “joint” and -itis meaning inflammation.
However, inflammation is typically absent in osteoarthritis until the later stages of the disease. Because of this, osteoarthritis can go by several different names including:
- Spinal Stenosis
- Degenerative Joint Disease
- Degenerative Disc Disease
The joints are the connection between two bones that allows movement, while providing support. In between the bones of the joint is a cavity filled with liquid known as synovial fluid.
Covering the ends of each bone is a type of flexible, yet strong, connective tissue known as articular cartilage. The synovial fluid acts like a shock absorber and helps to prevent wear and tear of this cartilage caused by friction.The cartilage further protects the bones from every day wear and tear and also helps to absorb shock.
Our spine, or vertebral column, is set up a bit differently than other joints. The spine is broken down into five different sections:
- The Neck, or Cervical Spine
- Mid-back, or Thoracic Spine
- Lower back, or Lumbar Spine
- Upper portion of the pelvic cavity, or Sacral Spine
- Tailbone, or Coccyx
It has 24 individual vertebrae (essentially the joints) and is covered in cartilage as well. However, the spine has gel-like pads, called discs, instead of cavities filled with synovial fluid.
These discs are filled with a fluid that is comprised of degenerated collagen, proteoglycans and water. This gel-like center is called the nucleus pulposus, and it acts as the shock absorber for the spine.
The Struggle is Real
I personally suffer from cervical (neck) osteoarthritis from a car accident in 1999. Not only do I have chronic pain in my neck from bone spurs that put pressure on my spinal cord, but I also suffer from chronic migraines caused by occipital neuralgia, which is caused by the compression of the vertebrae.
I take several medications to alleviate the pain, but these pills don't ever relieve 100% of the pain. Like most people who suffer with osteoarthritis, I go through every day in pain, which can lead to psychological and emotional changes.
But I have found a number of things that help alleviate my pain including exercise, a vegan diet, and fish oil supplements. Along with my daily pain medications, these lifestyle changes keep my pain levels under control and make life so much easier!
Symptoms of Osteoarthritis
Osteoarthritis causes the breakdown of the articular cartilage and primarily affects the weight bearing joints including the knees, hips and spine. However, it can affect any of the joints such as the fingers and toes.
As the articular cartilage degenerates, the bones begin to rub against each other causing friction. Over time, this friction causes the bones to become worn down essentially compressing the joint. In the later stages, this can cause inflammation, which exacerbates the problem and the pain.
Osteophytes, or bone spurs, begin to grow on the bones where the articular cartilage is worn down. This is Mother Nature’s attempt at healing the degeneration.
Unfortunately, bone spurs can lead to even more problems including interfering with the blood flow to the vertebrae and the curvature of the spine. This can cause stiffness in the joints and a very uncomfortable feeling called “locking.”
Locking is essentially a joint getting stuck. It can be very painful, or there may be no pain whatsoever. It can be very disconcerting, but normally the joint will unlock with a little bit of gentle manipulation. Osteophytes can also cause entrapment of the spinal nerves, and spinal stenosis (loss of space for the nerves to pass through).
Anatomy of the Vertebrae
Osteoarthritis is one of the leading causes of back pain, and the pain it causes in the joints is difficult to distinguish from muscle pain. When osteoarthritis settles into the spine, the vertebrae aren’t the only parts affected. The discs are affected as well.
Degeneration of the vertebral joints causes excessive strain on the discs, which can cause dehydration of the nucleus pulposus (the gel-like center) of the disc. As a result, the ability to absorb shock and lubricate the joint is lost. This can lead to a number of problems including:
- Bulging of the disc out of the vertebral space
- Compression of the vertebrae
- Herniation in which the jelly-like contents escape through a thinned portion of the disc wall and spill into the spinal canal, which can put pressure on the spinal nerves
Illustration of a Herniated Disc
Symptoms of spinal osteoarthritis can be very similar to other forms of arthritis. Some of these symptoms include:
- Stiffness in the neck or back, particularly the lower back
- Weakness, numbness or tingling of the legs and arms
- Migraines (caused by compression of the cervical vertebrae)
- Constant pain in the neck, or back that is only relieved by laying down
- Problems performing routine tasks and hobbies
- Psychological effects caused by chronic pain
Symptoms are typically worse in the morning and evening, and on humid, rainy or cold days.
Barometric pressure and weather changes (such as a change from warm to cool air) can exacerbate symptoms.
Because we sleep for 8 hours or more in the supine or similar position, osteoarthritis symptoms are typically the worst upon waking and for the first 30 minutes after rising.
Joints affected by the disease become stiff after long periods in a single position such as sitting or sleeping, and this stiffness can be very painful.
Crepitus, or cracking sounds, can occur after being in one position for long periods. The sound is caused by the bones of the joints rubbing together, or a bone spur rubbing against one of the bones of the joint. Crepitus tends to occur more frequently in the neck, hips and knees.
Many people with osteoarthritis notice improvement in their pain after exercising. I'm one of these people. Cardio exercise and weight training exercises have made a huge difference in my pain levels.
Causes of Osteoarthritis
As a degenerative disease, osteoarthritis can have many different causes. Some of these causes can include:
- Wear and tear due to aging
- Injuries such as whiplash
- A genetic cartilage defect
- Poor posture
- Repetitive movement
- Poor diet
- Other diseases such as diabetes or gout
Diagnosis of osteoarthritis is easily made with a patient history and physical examination. Diagnostic testing, if ordered, typically involves either an x-ray, or MRI (or both).
There are a number of various treatments for osteoarthritis. The most common treatments are analgesic medications such as NSAIDs (non-steroidal anti-inflammatory drugs) and pain killers. Other possible treatments are physical therapy, lifestyle modification and surgery.
Analgesic medications are the most common first line treatment when it comes to any type of arthritis. In the case of osteoarthritis, inflammation isn’t as much of a problem as it is in other type of arthritis such as rheumatoid. But there is still some inflammation especially in the later stages of the disease. Common over-the-counter analgesic medications include:
- Ibuprofen (Advil, Motrin)
- Naproxen Sodium (Aleve)
- Acetaminophen (Tylenol)
Prescription analgesic medications include:
- Tramadol (Ultram)
- Celecoxib (Celebrex)
- Topical or Oral Diclofenac (Voltaren Gel, or Voltaren)
- Oral Steroids (Prednisone)
- Topical Capsaicin
- Hyaluronic Acid Injections
There are several alternatives to prescription medications. Although, I use Voltaren Gel and Ultram, I also use alternatives which have alleviated the constant need for the prescription analgesics. My favorite treatments are:
- Vitamin C
- Vegan Diet
- Fish Oil
- Black Cohosh
Other alternative treatments include: turmeric, omega fatty acids 3, 6, 9, ginger, and glucosamine chondroitin. I’ve never tried any of these treatments so I can’t give an opinion on them. However, I can say that Vitamin C, Vitamin E and Black Cohosh are very effective.
Vitamin C is required in the production of collagen, which is the primary material of which ligaments and cartilage are made. Taking large doses of this vitamin helps prevent degeneration of the cartilage and therefore, osteoarthritis.
Vitamin E helps prevent inflammation by reducing C-reactive protein and other inflammatory markers. Vitamin A also acts as an anti-inflammatory. Black Cohosh specifically helps with spinal osteoarthritis because it improves the flow of the spinal fluid by preventing inflammation.
Niacin increases blood flow through the vasculature of the body, especially the capillaries. This increased blood flow reduces inflammation in the joints and relaxes muscles. It also allows the joints to move fluidly, reducing the amount of wear and tear to which they are subjected.
Acupuncture and Physical Therapy
Acupuncture for neck and back pain seems to work to alleviate current pain, but it doesn’t have any significant long-term effects. Physical therapy, on the other hand, does have long-term benefits. It also offers immediate relief for symptoms.
Manual traction performed by a skilled physical therapist can alleviate quite a bit of pain by opening up the compressed discs. Physical therapy can also help build muscles around the vertebral column, which can keep the vertebrae open after manual traction.
Many people don’t know that animal products (such as meat, milk and cheese) cause the pH of the body to become more acidic. To neutralize this change in pH balance, the body strips calcium from the bones.
For those who already have osteoarthritis, this exacerbates the problem. It can also increase the risk for those who have not developed the disease. Reducing the amount of animal products in the diet (or better yet, going vegetarian or vegan) can have a huge impact on the symptoms of osteoarthritis and its prevention.
Obesity is another problem. Being overweight puts more strain on the joints as well as the vertebral column, especially the lower back, than is natural. Losing even a few pounds can make a considerable difference in pain levels, and progression of the disease.
Usually a last resort, surgery (such as artificial knee replacements) can be necessary if the degeneration has completely destroyed the joint structure.
In spinal osteoarthritis, this typically involves removing a disc, and replacing it with an artificial disc, or fusing the vertebrae together. However, there is no guarantee that surgery will alleviate the pain, and in some cases can actually make the pain worse.
Osteoarthritis can be painful, but there are treatments available. If you think you or someone you know may have osteoarthritis, contact a physician as soon as possible. The earlier treatment is started, the faster pain can be relieved and life can return to normal.
Osteoarthritis, Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. MedlinePlus https://medlineplus.gov/ency/article/000423.htm
Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;4:465-474. PMID: 22563589 www.ncbi.nlm.nih.gov/pubmed/22563589.
Emily Delzell, Unhealthy Mix: Obesity and Osteoarthritis, Arthritis Foundation, http://www.arthritis.org/about-arthritis/types/osteoarthritis/articles/obesity-osteoarthritis.php