Spinal Osteophytosis
Definition: Outgrowth of immature bony processes from the vertebrae, reflecting the presence of degenerative disease and calcification. It includes cervical and lumbar spondylosis.

Synonym(s): Barre-Lieou Syndrome / Osteophytosis, Spinal / Posterior Cervical Sympathetic Syndrome / Spondylosis /

Narrow term(s): Hyperostosis, Diffuse Idiopathic Skeletal
Broader term(s) : Spinal Diseases - Bone Diseases - Musculoskeletal Diseases - Osteoarthritis - Arthritis - Joint Diseases

Web resources for Spinal Osteophytosis :

Cervical Spondylosis

Background: Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck (eg, disk herniation, spur formation), as well as the contents of the spinal canal (nerve roots and/or spinal cord). Some authors also include the degenerative changes in the facet joints, longitudinal ligaments, and ligamentum flavum.

Spondylosis progresses with age and often develops at multiple interspaces. Chronic cervical degeneration is the most common cause of progressive spinal cord and nerve root compression. Spondylotic changes can result in spinal canal, lateral recess, and foraminal stenoses. Spinal canal stenosis can result in myelopathy, whereas the latter 2 can cause radiculopathy.

Pathophysiology: Intervertebral disks lose hydration and elasticity with age, and these losses lead to cracks and fissures. The surrounding ligaments also lose their elastic properties and develop traction spurs. The disk subsequently collapses as a result of biomechanical incompetence, causing the annulus to bulge outward. As the disk space narrows, the annulus bulges, and the facets override. This change, in turn, increases motion at that spinal segment and further hastens the damage to the disk. Annulus fissures and herniation may occur. Acute disk herniation may complicate chronic spondylotic changes.

As the annulus bulges, the cross-sectional area of the canal is narrowed. This effect may be accentuated by hypertrophy of the facet joints (posteriorly) and the ligamentum flavum, which becomes thick with age. Neck extension causes the ligaments to fold inward, reducing the anteroposterior (AP) diameter of the spinal canal.

As disk degeneration occurs, the uncinate process overrides and hypertrophies, compromising the ventrolateral portion of the foramen. Likewise, facet hypertrophy decreases the dorsolateral aspect of the foramen. This change contributes to the radiculopathy associated with cervical spondylosis. Marginal osteophytes begin to develop. Additional stresses such as trauma or long-term heavy use may exacerbate this process. These osteophytes stabilize the vertebral bodies adjacent to the level of the degenerating disk and increase the weight-bearing surface of the vertebral endplates. The result is decreased effective force on each of these structures.

Degeneration of the joint surfaces and ligaments decreases motion and can act as a limiting mechanism against further deterioration. Thickening and ossification of the posterior longitudinal ligament (OPLL) also decreases the diameter of the canal.

The blood supply of the spinal cord is an important anatomic factor in the pathophysiology. Radicular arteries in the dural sleeves tolerate compression and repetitive minor trauma poorly. The spinal cord and canal size are also factors. A congenitally narrow canal does not necessarily predispose a person to myelopathy, but symptomatic disease rarely develops in individuals with canals larger than 13 mm.

Frequency:

• In the US: Cervical spondylosis is a common condition that is estimated to account for 2% of all hospital admissions. It is the most common cause of spinal cord dysfunction in patients older than 55 years. On the basis of radiologic findings, 90% of men older than 50 years and 90% of women older than 60 years have evidence of degenerative changes in the cervical spine.

• Internationally: Investigators in a study involving Ghanaians reported, "out of 225 patients who carried loads on their head, 143 (63.6%) had cervical spondylosis, and of the 80 people who did not carry load on their head, 29 (36%) had cervical spondylosis."

Mortality/Morbidity:

• The course of cervical spondylosis may be slow and prolonged, and patients may either remain asymptomatic or have mild cervical pain.

• Long periods of nonprogressive disability are typical, and in a few cases, the patient's condition progressively deteriorates.

• Morbidity ranges from chronic neck pain, radicular pain, diminished cervical range of motion (ROM), headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincteric dysfunction (eg, difficulty with bowel or bladder control) in advanced cases. The patient may be eventually chair-bound or bedridden.

Race: No apparent correlation between race and cervical spondylosis exists.

Sex: Both sexes are affected equally. Cervical spondylosis usually starts earlier in men than in women.

Age:

• Symptoms of cervical spondylosis may appear in those as young as 30 years and are most commonly in those aged 40-60 years. Radiologic spondylotic changes increase with patient age, as 70% of asymptomatic persons older than 70 years have degenerative cervical spine changes in one form or another. See also the Frequency section above.

• Cervical spondylosis usually starts earlier in men than in women.

• When cervical spondylosis develops in a young individual, it is almost always secondary to a predisposing abnormality in one of the joints between the cervical vertebrae, probably as the result of previous mild trauma.