Spine Problems as We Age: Part 1
|Written by Lloyd Maliner M.D.|
SeniorLiving.Org Expert on Neurosurgery | Spinal Surgery
It is commonly said that there are two certainties in life: taxes and death. Well, I want to suggest that there is a third; arthritis. The common type of arthritis, osteoarthritis, is not really a disease but simply the wear and tear of living on the joints. I often tell my patients to think of arthritis like rust on a hinge: it develops over time, it makes the surfaces irregular resulting in squeaking and stiffness, and if the hinge is not used it will get stuck. Another point I make is that a “joint” is where two bones meet and move, such as elbows and knees, but also including the various bones or vertebrae that make up the spine. Actually there are three joints between each two vertebrae, and twenty-five of these joint “levels” from the head to the sacrum. So there are many joints in the spine, each of which will wear down with use. No wonder almost everyone will develop some arthritic trouble in their back over time.
The most common spine problem of age is simply the stiffness and occasional discomfort due to arthritis. A common example is the trouble you have getting out of bed in the morning and feeling the need to “stretch” your back: this is arthritis in action. The longer you live, the stiffer and slower you will be in the morning. Granted that people start having arthritis symptoms at differing ages, but everyone will eventually understand what I am describing. The main factor that determines an individual’s severity of arthritis is probably genetics; but tobacco use, weight, and abusing the body also play a role. The majority of people suffering back problems due to arthritic or age changes simply need encouragement and occasional anti-inflammatory medication. However there are more serious arthritic spine problems that can develop, such as stenosis.
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Stenosis refers to narrowing or constriction around a neural structure, such as the spinal cord or a nerve. This occurs with arthritis because of bone spurs, which are like rust deposits in our analogy, developing around the affected joint. Think of the classic enlarged knuckle of the Wicked Witch of the West. With the hand knuckle, like most joints, the bone spurs simply interfere with the joint movement: which is actually their purpose. Your body is trying to “cure” the arthritis by fusing the joint with boney overgrowth. Once the joint is fused, it no longer moves, which means no more pain or irritation. Unfortunately that also means no more flexibility, which is very bad for elbows and knees but not as much a problem with the spine. In fact, the concern of “bone on bone” due to arthritis is not really a problem in the spine; it is almost a good thing. So in the spine the bone spurs can be helpful when they limit the irritation of movement, but the spurs are a problem when they pinch the adjacent nerves.
I have explained how the aging spine develops “rust” in the form of bone spurs, called osteophytes. These osteophytes can be problematic when they start to impinge on the nervous structures in a condition called stenosis. Stenosis can range from an asymptomatic finding on an xray, which means it is not causing any problems; to a devastating development including paralysis. The difference is in the degree of stenosis and what part of the spine is involved.
Updated: Feb 14, 2012