Spinal bone spurs
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The medical word for bone spur is osteophyte. An ostephyte occurs when normal bone is subjected to abnormal stresses and grows larger than normal. Osteophytes are an x-ray marker of spinal degeneration and are a normal finding associated with aging.
In almost half the population, degeneration and development of bone spurs will lead to symptoms of neck and back pain, radiating arm and leg pain and weakness in the extremities.
The spine consists of thirty-two vertebral segments that are separated by intervertebral discs made of collagen and ligaments. These discs function as shock absorbers and allow a limited degree of flexibility and motion at each spinal segment. The structural make-up allows full range of movement around the axis of the spine, especially the neck (cervical) and lower back (lumbar spine).
Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joints). Under each facet joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting (foramen) that surrounds the nerve (disc in front, joints above and below) is relatively small.
Traumatic injuries to the spine along with aging cause degeneration in the discs and the joints of the spine. With time, injury, poor posture, etc. there is cumulative damage to the bone or joints of the spine:
• As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint.
• Ligaments undergo wear and tear.
• Over time, the ligaments thicken and calcify, resulting bone spur formation.
• As the central spinal canal and the foramina ligaments thicken, compression of the nerves causes clinical symptoms.
Factors that can accelerate the degenerative process and bone spur growth include:
• Congenital or heredity
• Life-style, including poor posture
• Traumatic forces
Osteoarthritis of the facet joints is a common cause of back pain in the older patient population(> 60). This condition can cause stiffness and lower back pain that is usually worse in the morning, gets better after moving around, then gets worse again at the end of the day.
The most common cause of spinal arthritis is repetitive trauma to the spine from recreational or work related excessive strains. Patients may typically develop symptoms of osteoarthritis in their mid 40’s to early 50’s. Men are more likely to develop arthritic related symptoms earlier in life, however postmenopausal women rapidly approach men in incidence and severity of osteoarthritis.
Bony enlargement can sometimes lead to narrowing of the spinal canal and result in spinal stenosis. This condition can cause nerve and cord pinching, leading to pain down the legs that is worse when the patient stands and walks, and is better when sitting. Spinal stenosis cannot be prevented but it can be treated.
The most common symptom of spinal bone spurs is pain. The back pain or neck pain is very common as the facet joints become inflamed and the neck and back muscles become irritated. Patients usually complain of:
•Dull pain in the neck or lower back when they stand or walk
•Radiating pain into the shoulders (including headaches) if the cervical spine is affected, and buttocks and thigh if the lumbar spine is affected
The symptoms of bone spurs are made worse with activity and often improve with rest. Lumbar arthritis symptoms often improve when an individual is bending forward and flexing at the waist. Examples are when a person leans over a shopping cart or over a cane.
As the nerves become compressed, patients with bone spurs complain of several symptoms including:
• Pain in one or both arms or legs
• Progressive weakness
• If the arthritic processes and stenosis is severe, progressive bowel and bladder dysfunction occurs
Diagnostic evaluation begins with the clinical examination. A physician will perform a detailed neurological and spine evaluation assessing for spinal nerve and spinal cord compression.
Common diagnostic tests include:
• Electrodiagnostic tests are commonly performed to document the degree and severity of spinal nerve injury. The EMG and nerve conduction test (EMG/NCV) tests will exclude peripheral nerve compression such as carpal tunnel syndrome.
• X-rays determine the extent of arthritic changes and bone spur formation. With these films the physician may determine if destructive changes are present or further radiographic images are indicated.
• Computerized tomography (CT scans) or MRI scans can provide details about change in the spinal architecture and the degree of nervous system compression. With these results the clinician will correlate clinical symptoms with imaging findings and recommend the corrective course of action.
Most patients with mild or moderate nerve compression and irritation from bone spurs can manage their symptoms effectively with conservative care, such as:
• Medication, including anti-inflammatory medications and muscle relaxant pain medications, for approximately 4 to 6 weeks.
• After 1-2 weeks, physical therapy, exercise and manipulation often alleviate the painful joint conditions. Therapy attempts to restore flexibility and strength to the neck and back, improving posture and possibly decreasing the compression on the nerves.
• Epidural steroid injections have therapeutic value for some patients with facet joint inflammation by reducing the joint swelling and improving spinal pain and radiating extremity pain syndromes. The results are temporary, but repeat injections maybe indicated.
Spine specialty consultation is indicated if these conservative measures to treat bone spurs fail. Early referral is appropriate if patients suffer from severe pain or there is clinical evidence of nerve compression and damage.
Surgery (such as a laminectomy) relieves the pain and neurological symptoms by removing the bone spurs and thickened ligaments causing painful nerve compression. The majority of patients who undergo surgery for bone spurs experience good results. Medical conditions often associated with age, such as high blood pressure, diabetes and heart disease can influence surgical risks and slow the recovery processes.
Spine surgery for bone spurs is necessary if nerve or spinal cord compression causes unremitting pain or motor loss is documented on examination.
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