Degenerative spondylitis, also known as hypertrophic spondylitis, hyperplastic spondylitis, senile spondylitis, and spinal osteoarthritis, is a bone and joint lesion formed by degeneration of the intervertebral discs, osteophytes at the vertebral edges, and hypertrophic changes in the small joints. The disease occurs after middle age and is more common in men than in women. Clinically, it is often seen in the lumbar region where there is a large range of weight bearing and activity.
Why does degenerative spondylitis occur?
The causes are primary (or idiopathic) and secondary. In China, secondary cases are more common and primary cases are less common. Where normal vertebral joints gradually degenerate for no apparent reason is known as primary spondylolisthesis; if there is some known cause of cartilage destruction or structural changes in the joint, resulting in degenerative changes due to factors such as intra-articular friction or pressure imbalance, it is known as secondary spondylolisthesis.
Features of degenerative spondylitis
1. Back pain in the morning, reduced after activity
Most patients wake up in the morning and feel pain in the lower back, which is generally more tolerable, and is accompanied by limited activity and self-perceived stiffness in the lower back. But after a little activity, the pain is reduced, and then walk a few hundred steps, not only the pain is relieved or disappeared, the lumbar range of motion is gradually restored as normal.
2. Pain after more activities or weight-bearing, relieved after rest
Patients feel lumbar pain after too much activity or weight-bearing, and it gradually worsens, accompanied by limited activities. At this time, if the patient lies down slightly or rests properly on the sofa or recliner, the symptoms will improve significantly. Most of the symptoms of this group appear in the evening, i.e. after a day of activity, but in severe cases, they can also occur after 1 to 2 hours of activity.
3. Stiffness and soreness of the lower back
Unlike other patients with low back pain who mainly suffer from “pain”, they more often complain of restricted movement, inflexibility, soreness, stiffness and swelling of the lumbar joints.
4. No clear pressure point
Most patients do not have a clear fixed pressure point, and their symptoms are mainly caused by sinus reflex.
5.Uniform limitation of lumbar movement
In other words, the lumbar range of motion is restricted in all directions, and the range of restriction varies greatly, and the mobility of the lumbar spine can be nearly normal in the early cases, but the middle and late cases show different degrees of functional restriction.
6.Comfortable percussion
When the examiner taps the patient’s lower back, he or she reports a satisfactory feeling of comfort and hopes that the examiner will tap a few more times. This is mainly due to the stiffness of the ligaments of the small joints, slowed blood flow and venous stasis.
How to treat?
I. Treatment principles
1. Slow down the development of degeneration, relieve various symptoms and restore the patient’s normal life and working ability.
2. Non-surgical treatment is emphasized, and surgery is generally not required unless the nerve tissue in the spinal canal is compressed and cannot be relieved.
3.Enhance the function of the lumbar back muscles and supplement with effective medication; at the same time, we should also help patients overcome and prevent pessimism so that they can actively cooperate with the treatment.
Second, treatment methods
1.Non-surgical treatment
The following non-surgical treatment measures are commonly used in clinical practice.
(1) lying on a mattress of medium firmness or more
Specific requirements are to avoid too soft, such as the use of very thick sponge as a mattress is risky. Especially children, if long-term sleep in a particularly soft bed, is will affect the physiological curvature of the spine, resulting in a smaller physiological curvature, the impact on the growth and development of children. Too hard bed may also cause local blood circulation disorders due to compression of the soft tissue next to the spine, causing pain and discomfort, should also be avoided.
(2) Lumbar back muscle exercise
This is essential for the recovery of the lumbar function, and special counseling should be given at the beginning to avoid not getting the proper effect.
(3) Lumbar circumference protection
A soft waist brace with elasticity is ideal, but during the attack period, a stiffer leather waist brace should be used instead, or a lightweight lumbar back support should be used. Long-term wearing of lumbar girth may lead to disuse atrophy of the paravertebral muscles, so it is recommended to wear it only for 1-2 weeks during the acute attack of low back pain, and not for a long time.
(4) Drug therapy
Anti-inflammatory and analgesic drugs can be used as appropriate to relieve patients’ symptoms.
(5) Massage therapy
It can improve local blood circulation and is beneficial to the recovery of the disease, but massage, especially rough and heavy massage, is not only detrimental to the recovery of the disease, but also can aggravate the disease and should not be used.
(6) Other
Physiotherapy, local closure therapy, sports therapy, herbal topical application, acupuncture, light weight continuous traction in bed, etc. can be used as appropriate.
2.Surgical treatment
(1) Spinal fusion
For those with obvious instability of vertebral joints, or with posterior small joint injury arthritis, the corresponding spinal fusion can be selected. For those with simple vertebral joint instability, general posterior lumbar interspinous fusion, plate fusion or small joint fusion can achieve satisfactory results.
(2) Decompression of the spinal canal or root canal
This procedure can be considered for those with severe radicular or cauda equina symptoms in the late stage of the disease due to obvious hyperplasia. The lamina and spinous process are usually exposed under local anesthesia or epidural anesthesia, and unilateral root canal decompression, single vertebral segment decompression, or total laminectomy and decompression are performed depending on the condition, and the need for simultaneous fusion and fixation of the vertebral segment is determined by the stability of the vertebral segment.