Bone spurs (osteophytes) and back pain

Introduction to bone spurs and back pain
Many patients are told that they have "bone spurs" in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, bone spurs in and of themselves an simply an indication that there is degeneration of the spine; they are not necessarily the actual cause of the patient's back pain.

The term "bone spurs" is really a bit of a misnomer, as the term "spurs" implies that these bony growths are "poking" some part of the spinal anatomy and causing pain. However, this is not at all true. Bone spurs are in fact smooth structures that form over a prolonged period of time.

The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Basically, osteophytes are a radiographic marker of spinal degeneration (aging) and are by and large a normal finding as we age. Over the age of 60, bone spurs are actually quite common.

It must be stressed that degeneration of the spine occurs in all persons to some degree. However, for 42% of the population, degeneration and development of bone spurs will lead to symptoms of neck and back pain, radiating arm and leg pain and weakness in the extremities during their lifetime.

Anatomy and formation of bone spurs
The human spine is made of thirty-two separate vertebral segments that are separated by intervertebral discs made of collagen and ligaments. These discs are shock absorbers and allow a limited degree of flexibility and motion at each spinal segment. The cumulative effect allows a full range of movement around the axis of the spine, especially the neck (cervical) and lower back (lumbar spine).

Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joint). Under each joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting hole (foramina) that surrounds the nerve (disc in front, joints above and below) is relatively small and has little room for anything besides the exiting nerve.

Normal life stressors compounded by traumatic injuries to the spinal architecture cause degeneration in the discs and the joints of the spine. With age, injury, poor posture there is cumulative damage to the bone or joints of the spine:

1. As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint.

2. The body naturally and necessarily thickens the ligaments that hold the bones together.

3. Over time, the thick ligaments tend to calcify, resulting in flecks of bone or bone spur formation.

4. As the central spinal canal and the foramina thicken their ligaments, compression of the nervous system causes clinical symptoms.

Degenerative changes to normal vital tissue begin in early adulthood, but usually this slow process does not present with nervous system compression until we are in our sixties or seventies. Factors that can accelerate the degenerative process and bone spur growth include:

• Congenital or heredity

• Nutrition

• Life-style, including poor posture

• Traumatic forces, especially sports related injuries and motor vehicle accidents

As always, to help avoid or minimize back pain it is generally advisable to stay well conditioned (both in terms of aerobics and strength) and to maintain good posture throughout one’s life.