Spondylosis is the degenerative changes of spine. It may involve disc, facet joints of spine, ligaments and adjacent structures. It is very common after middle age. There is no direct correlation between these degenerative changes and pain. We frequently find severe degenerative changes in these structures without any pain. But sometimes it is associated with pain. We have to find out the exact pain generator or source of pain to start treatment. We may utilize different investigations like X-ray, CT-scan, MRI etc But in most situations these investigations are unable to locate the source of pain.
In such situations we have to use diagnostic interventional pain management procedures to assess the source. All these spinal structures have their individual nerve supply and pain is carried through these nerves. In diagnostic interventional pain management we are separately blocking one of these nerves to see the pain relief. If pain relief is significant that structure is the source of pain.
So spondylosis is a non-specific term, which means degeneration of spinal structures and has no relation with pain. This is a radiological diagnosis and do not help in treatment. We have to identify the degenerated structure, which is the source of pain by diagnostic interventional pain management procedures. Ultimately name changes according to the structures involved (like facet arthropathy) and this helps in treatment
Inflammation of facet joints and adjacent ligaments is called Spondylitis. The most common cause of Spondylitis is rheumatoid arthritis. Diagnosis is confirmed by clinical examinations, X-ray, CT-scan, serological tests etc.
- Treatment of rheumatoid arthritis itself with some disease modifying drugs.
- Exercises to strengthen back muscles.
- Surgical or interventional pain management procedures to correct instability, root compression or facet joint pain.
- Spondylosis, facet joint arthritis – Treated with facet joint injection, Radiofrequency ablation of medial branch, intramuscular stimulation (IMS) of paraspinal muscles etc.
Ankylosing Spondylitis is another cause of Spondylitis. It is predominantly found in males. Problem starts with back pain at early age and gradually it involves other joints, normally pain is restricted at the involved area without radiation of pain. Diagnosis is confirmed by typical bamboo spine appearance on pain X-ray. Disease gradually progresses with fusion of spine or other joints. Disease modifying drugs are effective in prevention of peripheral joints mainly. Main treatment is exercise along with different pain management options.