Jeffrey R. Carlson, MD
Spinal Osteoarthritis or Spinal OA is a form of wear-and-tear arthritis that affects the joints of the spine. The facet joints are located on the backside of each vertebrae and help the spine bend and twist. As we age, the cartilage in these joints may wear away with use and time. At the same time, our vertebral discs may start to degenerate. These discs which sit between our spinal bones and act as a cushion and shock absorber, are made mostly of a gelatinous substance containing a lot of water. When they degenerate, they lose water and flatten, which puts additional pressure on the facet joints of the spine. It can be a chicken or the egg type of scenario, as these two conditions are often seen together.
While we don’t know for sure what causes Spinal OA, there are risk factors, which include: age, being female, family history of OA, genetic cartilage defects, repetitive stress jobs and obesity. The symptoms of Spinal OA are back pain, limited range of motion, tenderness and soreness, pain when standing or sitting, which improves when lying down. There also can be weakness, numbness or tingling in the arms and legs, caused by irritated or inflamed nerves, which is called radiculopathy.
As a Spine Specialist, I am often consulted by patients for a diagnosis of Spinal OA (x-rays, thorough physical exam, lots of questions) and I usually manage the beginning of their treatment conservatively, which consists of oral anti-inflammatory medications, Physical Therapy, activity modification, bracing, hot/cold therapy, etc. If the patient does well and their pain resolves, this treatment will be continued.
Some patients will require interventional procedures for pain relief, such as epidural or facet joint injections, prolotherapy or radio frequency ablation of the nerves near the affected facet joints. I refer my patients to the OSC Interventional Pain Management Team for these procedures, which are often quite effective for pain relief and no further treatment will be needed beyond these interventions.
Unfortunately, there will be patients for whom the only answer is spinal surgery and that’s where I come back into the picture. When other non-surgical treatments haven’t been successful, I discuss with the patient the surgical options available to them and what I recommend based on their age, activity level and lifestyle. I want the patient to be well-informed, actively participate in the surgical discussion and choose the option that will help them to live the most active life they can once they recover.
A MR Scan will be ordered to ensure that I have the most accurate and detailed view of the patient’s spine so the surgical decision will be clear cut. For example, if the patient has facet joint arthritis, but also severe instability, a fusion with facetectomy (removal of the facet joints) may be the only surgical option that will stabilize the spine and relieve the patient’s pain. Another patient may be able to have pain resolution with only a microdiscectomy and a half facetectomy, while another could have only a laminectomy for pain relief. So much depends on how much spinal disc involvement there is, the stability of the vertebrae and how arthritic the facet joints are.
Unless the patient has underlying health conditions or insurance issues that preclude this, almost all of these spinal procedures can be done as outpatient surgeries, with the patient going home the same day. I order in-home nursing visits to make sure the patient is progressing; their surgical incision is healing well, and they are recovering according to plan. In some cases, I also order a Physical Therapist to come into the home to ensure that patient learns how to properly move after surgery and does exercises to build strength and restore function. Most patients follow up with me in the office about ten days – two weeks after surgery so that I can check their progress, remove stitches or staples and in many cases, release them to return to work and activity.