Spondylosis
Spondylosis is degenerative osteoarthritis of the spine, with facet joint arthropathy and disk degeneration producing anterolateral osteophytes and disk-space narrowing on imaging, most consequential in the cervical spine where it can compress a nerve root (radiculopathy) or the spinal cord (myelopathy), diagnosed clinically and with MRI when neurologic compression is suspected, and managed conservatively unless myelopathy or progressive deficit develops.
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What this article covers
- Overview
Spondylosis is degenerative osteoarthritis of the spine, driven by facet joint arthropathy and disk degeneration, and radiographically defined by anterolateral spinous osteophytes with disk-space narrowing.
- Epidemiology
A common radiographic finding with advancing age, reflecting cumulative facet joint and disk degeneration analogous to osteoarthritis elsewhere in the body.
- Risk factors
Advancing age, the dominant risk factor, reflecting cumulative facet joint and intervertebral disk degeneration across decades.
- Pathophysiology
Disk degeneration reduces disk height and disk hydration, shifting mechanical load onto the posterior facet joints.
- Clinical features
Chronic axial neck or back pain worsened by extension and rotation and improved by rest, without radiation, in mechanical (non-compressive) spondylosis.
- Differential diagnosis
Compressive cervical myelopathy from another cause (tumor, epidural abscess, disk herniation): distinguished from spondylotic myelopathy by an acute or subacute course, fever, or a mass lesion on MRI…
- Diagnosis
Spondylosis is confirmed as the first step by plain radiographs showing anterolateral spinous osteophyte formation with disk-space narrowing; the separate and more urgent question, addressed next, is…
- Management
First, classify the presentation: mechanical pain only, radiculopathy, or myelopathy, since myelopathy and progressive deficits change the management pathway from conservative to surgical.
- Complications
Cervical spondylotic myelopathy: progressive cord compression can produce permanent gait, bladder, or bowel dysfunction if decompression is delayed.
- Prognosis
Mechanical (non-compressive) spondylosis generally has a favorable prognosis with conservative management, and most patients have resolution or near-resolution of symptoms within weeks to a few months.
- Prevention
Encourage regular range-of-motion and core/paraspinal strengthening exercise 2-3 times weekly to reduce symptomatic flares from age-related degenerative change, which is not itself modifiable.
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