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Spondyloarthrosis (facet joint osteoarthritis)

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Spondyloarthrosis (facet joint osteoarthritis)

Spondyloarthrosis, or osteoarthritis of the intervertebral joint is a dystrophic process that damages the intervertebral joints of the human spinal column. At the initial stage of development of damage to the articular surfaces and the capsule of the intervertebral joints, spondyloarthrosis will be preceded by arthritis (inflammation) of these joints. The development of spondyloarthrosis of the intervertebral joints occurs gradually and already in adulthood may be physiological. The occurrence of spondyloarthrosis of the intervertebral joints can be promoted by trauma and chronic overload in the motor segments of the spine.

The most susceptible to spondyloarthrosis of the intervertebral joints are those parts of the spine where the maximum range of motion occurs. Spondyloarthrosis of the intervertebral joints most often develops in the cervical and lumbar spine, where flexion, extension, as well as rotation and rotation, occur.

The development of spondyloarthrosis of the intervertebral joints occurs gradually and already in adulthood can be physiological.

Spondyloarthritis is the most common type of damage to the intervertebral joints. Osteoarthritis of the intervertebral joints usually occurs in elderly patients. The disease can develop in any part of the spine (cervical, thoracic, lumbar). Most often, osteoarthritis of the intervertebral joints (spondyloarthritis) in patients affects the cervical and lumbar spine with the corresponding localization of the symptoms of this disease.

Patients with osteoarthritis of the intervertebral joints complain of pain in the spine. The pain in the spine increases with movement, while there is stiffness and limitation of movement in the intervertebral joints. Nonspecific symptoms (fatigue, malaise, fever) in patients with osteoarthritis of the intervertebral joints are absent. The existing pain goes away at rest.

The severity of the symptoms of the disease may not correspond to the x-ray of the spine. Pain occurs even with minimal changes visible on radiography. At the same time, significant growth of the osteophyte with the formation of a spur, a ridge, and a bridge between the vertebrae can be found in middle-aged or elderly patients, without complaints of pain. The changes to which the intervertebral joints of the cervical and lumbar spine undergo spondyloarthritis can cause compression of the roots of the spinal nerves, cauda equina, or spinal cord. In such a situation, against the background of spondylitis, patients develop myelopathy or radiculopathy.

With spondyloarthritis of the intervertebral joints, the articular surfaces and the capsule of the joint will be changed.

The multiple radiculopathies of the nerve roots at the lumbar level arising in spondylitis are one of the variants of the clinical manifestation of hypertrophic arthritis. In the presence of congenital narrowness of the spinal canal of the lumbar spine in its lower part (level LIV and LV vertebrae), the patient is prone to damage to the intervertebral discs or spondyloarthritis. Osteoarthritis of the intervertebral joints progresses, narrowing the lumen (stenosis) of the spinal canal. Stenosis leads to mechanical compression of the lumbar spinal nerve roots and even to blockage (occlusion) of the spinal canal. The nerve roots are trapped in the space between the posterior surface of the vertebral body and the yellow ligament. In the wake of lower back pain, patients develop weakness in the legs, decrease Achilles and knee reflex, numbness, and paresthesia of the feet and legs. Straightening of the lumbar lordosis while walking and in a standing position provokes or increases the intensity of the neurological symptoms already present in the patient. Conversely, lower back flexion can eliminate them. The clinical symptoms and alternating attacks of pain correspond to the so-called intermittent claudication in spinal cord disease.

Patients with spondyloarthritis of the intervertebral joints often complain of pain, heaviness, and stiffness in the neck or lower back in the morning, which passes within several tens of minutes to an hour after the patient "disperses" or stretches for several tens of minutes to an hour.

In the acute stage of the disease, sharp pains with muscle stiffness occur. Such a protective muscular reaction to pain, leading to a change in posture and the emergence of an analgesic posture (antalgic scoliosis) with limited range of motion, can later in itself become a source of problems for the patient if the treatment is not correct. The formation of a secondary muscular-tonic syndrome with fibromyalgia and typical trigger points in the muscle bundles is possible.

Stenosis (narrowing) of the lumen of the spinal canal with compression of the spinal cord with hypertrophy of the posterior longitudinal and yellow ligaments.

 

Diagnostics of the spondyloarthrosis of the intervertebral joints

The diagnosis of spondyloarthritis or arthrosis of the intervertebral joints of the spine is not difficult for clinicians at the moment. On consultation with a doctor, if the patient has typical complaints and the results of an external examination of the biomechanics of the spine, one can suspect the development of spondyloarthritis of the intervertebral joints. As a visualization of the level of joint damage, an overview X-ray of the spine is prescribed. In more complex diagnostic situations, CT of the spine or MRI of the spine may be recommended.

Computed tomography (CT) of the spine demonstrates changes in spondyloarthritis of the intervertebral joints.

This diagnosis is suggested based on medical history and spinal x-ray findings. To clarify the diagnosis in detail, the patient is prescribed myelography, computed tomography (CT), or magnetic resonance imaging (MRI). With these hardware diagnostic procedures, a narrowing of the canal of the lumbar spine (stenosis) is revealed in the patient.

Radiography of the spine in a direct projection with spondyloarthritis of the intervertebral joints.

 

Treatment of spondyloarthrosis of the intervertebral joints

Treatment of spondyloarthritis of the intervertebral joints consists of several factors of influence and the damaged articular surfaces in the patient. The standard course of treatment for spondyloarthrosis of the intervertebral joints lasts from 1 to 3 weeks and includes:

  • drug therapy (NSAIDs, analgesics, hormones)
  • physiotherapy (UHF, TENS, etc.)
  • manual therapy
  • massage
  • therapeutic injections
  • spinal traction (not performed in the acute stage!)
  • medical gymnastics and swimming (after the main course of treatment)

It is advisable to carry out several treatment courses, even if the patient with spondyloarthritis does not have an exacerbation of the disease. Thus, it is possible to significantly reduce the risk of recurrent exacerbation of pain syndrome and prevent the delay in the treatment of spondyloarthrosis for years.

Restoration of the volume of lost movements in the spondyloarthrosis of the intervertebral joints in the course of treatment is the key to preventing premature destruction of intervertebral discs, which could lead to the formation of protrusions and herniated discs in the cervical and lumbar spine.

In the treatment of spondyloarthrosis, the elimination of puffiness, inflammation, soreness, and restoration of the range of motion in the intervertebral joints of the lumbar spine is accelerated by the use of physiotherapy.

The facet joints can also be treated with blockages when conventional treatment for spondyloarthritis is not beneficial. Usually, low doses of anesthetic and cortisone injected into the lumen of the affected joint are sufficient for this method of treating spondyloarthrosis. When combined with a properly selected physiotherapy regimen, these injections can have a good and long-term effect on lumbar and sacral pain.

If the treatment is ineffective in relieving the articular pain syndrome in spondyloarthritis in such patients, minimally invasive radiofrequency destruction of the painful endings of the joint affected by spondyloarthrosis can be performed. The procedure for radiofrequency destruction of painful endings is easily tolerated by patients and is performed on an outpatient basis, without requiring hospitalization.

Hemilaminectomy operation for decompression of the spinal cord and nerve roots with hypertrophy of the posterior longitudinal and yellow ligaments.

An operation to decompress the contents of the spinal canal eliminates the symptoms of compression of the nerves and spinal cord. To prevent possible postoperative spinal instability, stabilizing systems are installed. Radiculopathy of the roots at the level of the lumbar spondylitis in neurological manifestations is similar to myelopathy of the cervical spinal cord. Radiculopathy of the lumbar spinal nerves is manifested by cauda equina syndrome.