osteoarthritis of the spine

Pathology

• most common in facet joints of C6-C7 & L3-S1

Clinical manifestations

• lumbosacral osteoarthritis
  • early morning stiffness for < 30 minutes
  • no red flags: radiculopathy,
  • pain localizes poorly
  • pain aggravated by movement, relieved by rest
  • may radiate to paraspinal areas or buttocks
  • osteophyte encroachment on a nerve root may produce radicular symptoms, L4-L5 & L5-S1 most commonly involved
  • acute symptoms may be superimposed on chronic mechanical low back pain
• cervical spine osteoarthritis
  • stiffness & decreased range of motion
  • lateral flexion & extension generally more limited than forward flexion
• osteoarthritis of the hands would be supporting evidence

Laboratory

• laboratory testing in the absence of clinical evidence of a systemic disorder is not indicated

Radiology

• X-ray of spine
  • features: disc space narrowing, osteophyte formation, subchondral sclerosis, & facet joint osteoarthritis
  • indications:
    • confirmation of the diagnosis of spinal osteoarthritis
    • to assess severity of the disease
    • presence of radiographic changes does not always correlate with severity of symptoms experienced by the patient
• MRI of spine if diagnosis is uncertain

Differential diagnosis

• spinal stenosis
• muscle spasm
• nerve root compression
  • C6 & C7 most commonly involved
  • weakness in wrist extensors & biceps, decreased biceps DTR, decreased sensation in thumb & index finger suggest C6 involvement
  • weakness of the triceps, decreased triceps DTR, decreased sensation in index & middle fingers suggest C7 involvement
• diffuse idiopathic skeletal hyperostosis (DISH)

Management

• identify & eliminate provocative activities
• weight reduction, back posture, abdominal muscle strenthening
• acetaminophen or a short course of NSAIDs
• gabapentin or tricyclic antidepressant for neurogenic pain
• glucocorticoid injections may be useful
• consider opiates & other pain management stategies for refractory pain
• see osteoarthritis

More general terms

• osteoarthritis (OA)

Additional terms

• diffuse idiopathic skeletal hyperostosis (DISH, Forestier disease, ankylosing hyperostosis of the spine, spondylosis hyperostotica)
• facet/zygapophysial/interarticular joints
• low back pain (LBP)
• spinal stenosis
• vertebra

Patient information

osteoarthritis of the spine patient information