Diagnosing Osteoarthritis of the Spine
Pain and stiffness in the cervical (upper) spine and lumbar (lower) spine can have many causes. The spine specialists at Och Spine at NewYork-Presbyterian may take the following steps to find out what is causing your symptoms and determine if you have osteoarthritis:
- Take medical history to learn when your symptoms began, what makes them feel better or worse, and how they affect your activities. The doctor will also ask you about your family medical history, your job, and activities, as well as any prior medical conditions or injuries that may have put you at risk for osteoarthritis.
- Physical and neurological exams to assess your range of motion, muscle strength, pain, and sensation.
- Imaging exams such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI), help show the bones, discs, and nerves in and around your spine.
- Diagnostic injections using a local anesthetic applied into a joint or near a nerve to isolate the source of pain and confirm or rule out certain diagnoses.
Non-Surgical Treatment for Osteoarthritis of the Spine
For many people with mild spinal osteoarthritis, therapies that avoid surgery are sufficient to reduce pain and stiffness. Our doctors try these approaches first to see if they are beneficial for you.
Your doctor may recommend certain steps you can take on your own to relieve spinal osteoarthritis symptoms, such as:
- Achieving and maintaining a healthy weight.
- Avoiding smoking, which causes damage to the blood vessels and can increase the risk of degenerative diseases of the spine.
- Getting regular physical activity, including cardiovascular workouts and strength training. Walking, swimming, and water aerobics are gentle exercises that may help relieve your symptoms.
- Maintaining good posture when you are sitting, standing, working, and moving
- Sleeping in positions that do not aggravate your symptoms.
Applying a heating pad, hot compress, or ice pack to the painful areas of your back for 15-20 minutes at a time may bring relief. Warmth can soothe achy muscles, and a cold compress can help reduce inflammation. Speak with your doctor to determine which might be best for you.
Physical therapy exercises
Physical therapy is a common treatment for spinal osteoarthritis. Physical therapists help patients learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility.
Components of physical therapy may include exercises you learn with your therapist and do at home to stretch and strengthen your muscles. Your therapist will choose the exercises that are most effective for you. During a physical therapy session, your therapist may also perform manual therapy to enhance your mobility and alignment. Over time, increased strength and range of motion in your spine can provide support and ease the stress on arthritic joints.
Over-the-counter and prescription medications are widely used to relieve the pain caused by spinal osteoarthritis. The medication recommended by your doctor will depend on the type, location, duration, and severity of your back pain. These medications include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- Pain-relieving creams that are applied to the skin at the site of discomfort
- Prescription muscle relaxants or anti-inflammatory drugs; gabapentin or pregabalin may be prescribed if nerve pain is present
Some people with osteoarthritis receive injections into the spine to see where the pain is coming from and to relieve it, often enabling them to participate in physical therapy more comfortably. Your doctor may recommend these treatments to relieve your pain if other non-surgical therapies are not working well to reduce your neck or lumbar pain, or if you cannot take oral pain medications. These treatments are given using X-ray guidance to direct their placement and include:
- Medial branch block. The doctor injects a numbing medicine (anesthetic) near the small medial nerves connected to a specific joint in the spine, called the facet. If the patient feels pain relief immediately and it is sustained for a few hours, then the doctor knows that the facet joint is the source of the pain. Usually, a confirmatory block is done on another day, and if that is temporarily helpful, you and your doctor may elect to pursue radiofrequency ablation.
- Radiofrequency ablation. Also called radiofrequency neurotomy, this treatment can relieve pain for a longer period of time (typically 6 months to a year) than other injection therapies. The doctor applies radiofrequency energy (focused heat) through a special needle to the affected nerve. This energy creates a "heat lesion" in the nerve that inhibits its ability to send pain signals to the brain.
- Intra-articular steroid injection. An injection of a medication such as a corticosteroid is applied into an arthritic spinal joint and works to reduce inflammation.
Surgery for Spinal Osteoarthritis
When spinal osteoarthritis symptoms persist despite lifestyle changes, physical therapy, medications, or cortisone injections, it may be time to consider surgery. Spinal osteoarthritis surgery has helped many people reduce their pain and regain their independence, enabling them to get back to doing the things they most enjoy. The spine surgeons at Och Spine offer all types of spinal arthritis surgery and will let you know if one of them is likely to be helpful for you. They use augmented reality technology and computer-guided navigation to complete these procedures with precision and safety.
Spinal decompression surgery
During decompression surgery, the spine surgeon may relieve pressure on the spinal cord or spinal nerves caused by bone spurs. The surgeon removes the bone overgrowth to relieve impingement on the cord or a nerve. The goal of this approach is to provide more room for the spinal cord or nerve roots in an arthritic joint. This procedure can bring rapid relief to someone suffering from bone spurs in the back or neck.
A spinal implant may be used to provide stability to a joint affected by osteoarthritis. These implants are usually made of metal and designed to attach to one segment of the spine. Implants include cages, hooks, plates, screws, and rods; your surgeon will let you know which is best for your case and what to expect from the surgery. The implant may slightly reduce the range of motion but brings relief by widening the space between two vertebrae that may be rubbing against each other.
Spinal fusion surgically unites two vertebrae that are grating against each other. Using titanium instrumentation, the surgeon fuses the bones so there is no longer any motion between them. Our surgeons can often perform spinal fusion using minimally invasive means, operating through small incisions. While spinal fusion reduces the range of motion in the fused joint, it greatly relieves the pain that had been caused by osteoarthritis.
Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian
Spinal osteoarthritis is one of the most common back problems in America, but there is no reason to suffer or let it interfere with your activities.
The arthritis specialists at Och Spine use the latest diagnostic technologies and nonsurgical and surgical approaches to help people with spinal osteoarthritis get back to moving with comfort. Whether you need guidance to manage the discomfort of mild arthritis or a more intensive surgical procedure, we have the team for you.