Derived from the Greek words spondylos (spine),
lysis (to break down), and olisthanerin (to slip),
spondylosis and spondylolisthesis are relatively
common conditions. However, spondylolysis and
spondylolisthesis may cause back pain and other
related problems. Spondylosis describes degenerative
changes in the discs and joints of the spine that
produces a narrowing (stenosis) of the spinal
canal. In addition to the degenerative changes
in spondylosis, spondylolisthesis also involves
a slippage of one vertebrae off of the vertebrae
below it. Spondylosis can be a condition that
can trigger spondylolisthesis, but spondylolisthesis
may also occur alone.
Causes
Spondylosis can be a congenital condition or may
result from injury to the spine. Spondylosis may
be caused by ingrowth of bony spurs, buckling
of the ligaments around the spine or a disc herniation.
There are usually three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor
may order.
MEDICAL HISTORY
Your physician likely will ask about your activities,
which may be causing the pain in your back. Your
physician may ask when the soreness or pain began.
If you have had any prior back injuries, your
physician will ask about surgeries and/or treatments
you have tried in the past. Physicians also typically
ask about other conditions, such as diabetes and
allergies, and medications currently being taken.
Family history of chronic or serious back problems
is also considered when making the diagnosis.
You may also be asked about your physical and
athletic goals – information that will help
your physician decide what treatment might be
best for you in achieving those goals.
PHYSICAL
EXAM
Your physician usually
can make an early assessment of a spine problem
by finding tender spots along your spine. During
this assessment, your physician will feel various
muscles and bones throughout the spine. While
asking you questions to pinpoint the origin of
your pain, your physician typically will test
flexibility by checking your back's range
of motion, and may examine your stride as you
walk about the room. Physicians will test the
function of nerves and muscles in your back and
legs by checking your reflexes. Your posture is
usually observed for abnormalities while you sit
and stand.
Should your physician require a closer look, these
imaging tests may be conducted:
X-rays
help identify the changes in the vertebrae including
development of bony spurs that are typical of
spondylosis. X-rays can clearly show the "slippage"
of one vertebrae over another seen in spondylolisthesis.
CT
(computed tomography) scans are used to look for
bone/vertabrae injury and can show the shape and
dimesions of the spinal canal. This test is very
good for evaluating fractures.
MRI
(magnetic resonance imaging) uses magnetic waves
to create pictures of your back that show bones,
tendons, and ligaments. Your spinal cord and nerve
roots can often be evaluated with MRI, which is
excellent for evaluating soft tissue injuries
or spinal cord/nerve problems.
An
EMG (electromyogram) creates images that help
doctors evaluate nerve and muscle function. EMGs
are helpful in the evaluation of radiculopathy
(spinal nerve injury).
Bone
scans can assess any structural flaws in the bone
tissue of your vertebrae. This is an important
test for the evaluation of stress fractures.
The following clinical tests are commonly performed:
Blood
and urine samples help rule out infections, arthritis,
and other conditions.
Facet
blocks help locate the injured area of the spine.
Doctors inject a pain-blocking drug into the nerves
surrounding one vertebra at a time until they
identify the specific painful area.
Provocative
discography is an injection of saline solution
into the suspected injured area to reproduce the
pain, followed by an anesthetic to dull the pain.
