In clinical work, we often encounter the phenomenon of panic among patients who do not understand some terms in imaging reports. The harm caused by excessive fear that they have a serious disease and seek medical help everywhere, causing unnecessary mental stress and even giving excessive treatment, should not be ignored. I will explain some common terms and concepts below, hoping to provide some help to you. Yang Jincai, Department of Orthopedics, Beijing Chaoyang Hospital I. What is “degeneration” Degeneration is short for degenerative change, which refers to the decline of the function of a system or organ of the human body due to ageing. In other words, it is the “aging” of an organ or system of the human body. Its manifestations vary depending on the organ or system, such as muscle atrophy, brain tissue atrophy, slowed conduction of the nervous system, memory loss, osteophytes and osteoporosis of the skeletal system, destruction and wear of joint cartilage, loss of skin moisture and wrinkles, etc. Degeneration is not necessarily a “disease”, but a manifestation of the aging of the human body, and only becomes a disease when the degeneration is severe and the corresponding symptoms appear. For example, if the lumbar spine degenerates and the nerve root is compressed, the patient will experience numbness, pain, muscle weakness and atrophy in the innervated area before it is called a disease. There are many terms for common degenerative manifestations in imaging reports. The common degenerative terms for spinal X-ray are as follows: osteophytes, bone density reduction, spinal space narrowing, nerve root canal narrowing, lateral saphenous fossa narrowing, ligament calcification, etc. The common degenerative terms for joint X-ray films are as follows: joint edge hyperplasia, joint space narrowing, etc. The difference is that degeneration of bone joints is the manifestation of osteoarthritis, and as long as there is pain symptoms can be diagnosed osteoarthritis. The concept of “bone spur” Bone spur refers to the proliferative changes of bone seen in imaging, because its appearance is like a “spur” in imaging, so people usually call it “bone spur” figuratively. “Bone spurs Bone spurs can occur in many places throughout the body, most commonly in the spine and around joints, and most often in the spine around the edges of vertebrae and small joints. In fact, bone spurs are a form of self-protective response to the physiological degeneration of the human skeletal system, and are generally considered to be a proliferative response to the repeated external stimulation of the skeletal system. As mentioned earlier, bone spurs are a manifestation of degeneration, so I will briefly describe the mechanism of bone spurs in the spine and joints. It is believed that the degeneration of the spine starts with the degeneration of the intervertebral discs, which leads to the loss of water due to the metabolic disorders of the intervertebral discs, resulting in the loss of the height of the intervertebral space and the intervertebral motion, which increases the pressure on the small intervertebral joints. Since intervertebral motion is the basis of spinal motion, this change in intervertebral motion causes a corresponding change in the stress on the intervertebral discs, small joints and surrounding ligamentous structures, and a slight injury to the bone occurs where the stress load increases. The stimulation of repeated injuries results in repeated repair processes, and long-term repetition results in a series of changes such as osteophyte reaction (i.e., spur formation) and ligamentous hyperplasia and calcification, which are collectively referred to as degenerative changes because they are all caused by degeneration. The principle of periarticular bone spurs is basically the same as that of spinal bone spurs, except that the initiating factor of joint degeneration is the degeneration of articular cartilage. The articular cartilage is not vascularized, and its nutritional supply depends on the infiltration of bone, mainly from the joint fluid secreted by the joint capsule. The disruption of the secretion of joint fluid and the decrease in its quality are the main reasons for the destruction of articular cartilage. This means that when we see visible bone spurs forming around the bone joints, there is already significant damage to the articular cartilage. At this point, the diagnosis of osteoarthritis can already be established. Bone spurs grow as people age, and they can develop after the age of 30. What are the dangers of bone spurs? Is it a disease? Many people still have a vague idea. Many people think that having a bone spur is a disease. There are many medications and even “hospitals” that specialize in treating bone spurs, so people are more anxious about them. First of all, it is important to clarify the concept that a bone spur is not a disease per se, but a pathological reaction to the degeneration of the human body, as already described. A bone spur is only a disease if it causes pain or dysfunction after it has been created. Here is an example. A male patient in his 40s came to the clinic with lumbar pain. He complained of intermittent low back pain for 3 years aggravated for 1 week, with symptoms of lumbar pain after prolonged standing or sitting, and persistent pain in the past 1 week. After X-ray examination, the anterior and posterior edges of the lumbar vertebrae had obvious osteophytes, namely “bone spurs”. So, can we say that bone spurs are the cause of lumbar pain? Of course not. The patient is a desk worker (office work) and the physiological curvature of the lumbar spine has disappeared (I will have a lecture on the physiological curvature and function of the spine later). Let’s analyze the diagnosis and treatment of this patient and the causes of the disease. The patient worked for a long time, working more than 6 hours a day, sitting in a “relaxed position”, i.e., bowed back, and this long-term incorrect sitting position led to muscle strain on the lumbar back, and the relaxation of the muscles caused the body to stress the ligamentous structures around the lumbar spine, resulting in damage to the ligamentous structures around the lumbar spine, mainly the lumbar fascia and the supraspinous The ligaments around the lumbar spine, mainly the lumbar fascia and supraspinous ligaments, are damaged and cause inflammation leading to pain. At the same time, due to changes in lumbar spine stress, the stimulation of stress at the anterior and posterior edges of the vertebral body produces osteophytes, and obvious bone spurs can be seen on x-ray. The bone spur is not causally related to the pain, as the inflammation of the lumbar spine ligaments are both the result of the same incorrect sitting posture of the lumbar spine. In other words, the bone spur is not a disease, but one of the many manifestations of a disease. After treatment with anti-inflammatory and pain-relieving drugs, the lumbar pain can disappear, while the proliferating bone spur remains and grows with age. It is thus understood that bone spurs are not a disease, but rather a manifestation of a disease. When can a bone spur cause a disease? The bone spurs around the joints mentioned above are evidence that osteoarthritis has occurred, but it is not the spurs that cause the disease to develop, it is the breakdown of the cartilage in the joints that causes the arthritis. Bone spurs can be one of the many causes of spinal disorders. When a bone spur compresses the spinal cord, it can be said that the bone spur has caused the disease, but it is usually one of many contributing factors. In any case, don’t worry when you find a bone spur, as I often compare it to a “wrinkle” in the bone. It is just a sign of aging.