Arthritis of the Spine

Condition

Osteoarthritis: is also known as degenerative joint disease. It is a condition in which the protective cartilage that cushions the tops of bones degenerates, or wears down. This causes swelling and pain. It may also cause the development of osteophytes, or bone spurs.

Osteoarthritis of the Spine: The breakdown of the cartilage of the joints and discs in the neck and lower back. Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs.In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes:

  • injury or trauma to a joint
  • a genetic defect involving cartilage

For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints.

Symptoms of Osteoarthritis of the Spine: Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down. Some people experience little interference with the activities of their lives. Others become more severely disabled.

In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.

Osteoarthritis Diagnosis: The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.

The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:

  • X-rays to look for bone damage, bone spurs, and loss of cartilage or disc; however, X-rays are not able to show early damage to cartilage.
  • Blood tests to exclude other diseases.
  • Magnetic resonance imaging (MRI) to show possible damage to discs or narrowing of areas where spinal nerves exit.

From: WebMD

Treatments

Lumbar Facet Blocks: A lumbar facet joint block is an injection of local anesthetic (numbing medicine) into one or more of the small joints located along the side of each vertebrae on both sides of the spine in the lower part of the back. Multiple injections may be performed, depending upon how many joints are involved. Facet joint blocks are typically requested for patients who have pain primarily in their back as a result of arthritic changes in the facet joints or for patients who have mechanical low back pain. A facet joint block may be diagnostic (a test to see if your pain is coming from this area) and/or therapeutic (to relieve your pain).

From: University of Maryland Medical Center

Lumbar Facet Radio Freqeuncy Ablation: Radiofrequency ablation is a minimally invasive procedure that is usually performed with local anesthetic and mild sedation. As with many spinal injections, radiofrequency neurotomy is best performed under fluoroscopy (live x-ray) for guidance in properly targeting and placing the needle (and for avoiding nerve or other injury).

Radiofrequency Ablation Steps:

  • An intravenous (IV) line is often started so that relaxation medicine (sedation) can be given.
  • The patient lies on a procedure table and the skin over the neck, mid-back, or low back is well cleaned.
  • The physician numbs a small area of skin with numbing medicine (anesthetic), which may sting for a few seconds.
  • The physician uses x-ray guidance (fluoroscopy) to direct a special (radiofrequency) needle alongside the medial or lateral branch nerves.
  • A small amount of electrical current is often carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the neck or back.
  • The targeted nerves will then be numbed to minimize pain while the lesion is being created.
  • The radiofrequency waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve’s ability to send pain signals.
  • This process will be repeated for additional nerves.

From: Spine-Health

Staff

Jonathann Kuo, MD
Pain Medicine / Executive Director
Alexander Rances, DO
Pain Medicine / Medical Director
Robert Zhang, MD
Pain Medicine / Anesthesiology

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