Did you know that Spinal Osteoarthritis is the number one cause of lower back pain in those over the age of 50? While it is most commonly seen in the lower back, it can also occur in the neck. This is the kind of arthritis that is known as “wear and tear” arthritis and typically comes with age. Being overweight increases your risk and there is a genetic component to OA. As of today, there is no known cure for Spinal Osteoarthritis, but it can be effectively managed. In this article, I will discuss this ailment, its symptoms, diagnosis, and the treatments currently available.
Often, people assume that arthritis forms in the spine, in-between the vertebrae and the spinal discs that cushion the vertebrae. Arthritis only forms in joints and the spinal vertebrae/discs aren’t joints. Even so, the discs can degenerate in a condition called Degenerative Disc Disease and are typically seen concurrently with Spinal OA. Many researchers believe that degenerating spinal discs which put undue stress upon the facet joints are the cause of osteoarthritis in the spine.
Each vertebral section has two facet joints located between and behind it. These little joints help our spines to bend and twist in a variety of ways while helping to bear the weight of our upper body. Both of these joints have cartilage and synovial fluid in them to help with lubrication and smooth movement against the other joint surfaces. When arthritis strikes these joints, pain, stiffness and loss of function can be the result.
As an Interventional Pain Management Physician, I am often consulted after a patient has tried at-home remedies, has seen their PCP and even an Orthopaedist for their pain. The patient has typically already tried OTC pain relievers, prescription anti-inflammatory medications, Physical Therapy, behavior and activity modification, and perhaps even surgery, but still has a significant level of pain.
My consultation includes an exhaustive review of medical notes and history, a thorough physical exam of the patient and asking a lot of questions about the patient’s life, activity level and what helps or increases the pain. I don’t want to repeat therapies that have already been tried without success but instead would rather focus on therapies that haven’t been tried.
One of the first treatments I recommend is a facet joint injection which delivers corticosteroid directly into the arthritic facet joint of the spine. I perform this procedure using in-office fluoroscopy (live X-Ray) to place the medication precisely where it is needed. Often, these injections reduce inflammation for months or more, so the patient sees a significant reduction in pain and a return to function. If necessary, we can repeat these injections as often as once every three months.
Facet joints are complex structures that are situated near nerves, ligaments, and other soft tissues, all of which can become inflamed and irritated like the joint itself. I treat sore spinal ligaments using prolotherapy, which is an injection of irritant solution (usually sterile sugar water). This sugar water solution will at first increase the amount of inflammation in the ligament and cause the body to send its own healing agents to the area, speeding repair and then reducing pain.
Spinal nerve roots emerge from the spinal cord and run directly through the facet joints to innervate the arms, legs hands and feet. Inflamed nerves that do not respond well to injected steroid treatment may respond to radiofrequency ablation or RFA. This treatment option feeds a needle into the area near the nerve, the needle is then heated, and the myelin sheath is burned off of the nerve. This disrupts the painful nerve signal to the brain. The myelin sheath will eventually grow back; however, the pain signal may be gone permanently or more commonly, temporarily. The RFA procedure can be repeated, as necessary.
Spinal cord stimulation or neuromodulation is it treatment that can be tried by the patient during a seven-day trial. A temporary lead is placed into the epidural space and a gentle electric current is fed through it, interrupting the pain signals to the brain. This stimulus can be adjusted up or down in intensity and can be turned on or off according to the patient’s pain level. If the patient feels significant relief over the trial period, the patient can choose to have the spinal cord stimulator permanently implanted.
At OSC, in conjunction with all our procedural treatments, we are fortunate to have a pain psychologist as part of our interdisciplinary pain management program. Our comprehensive, patient-centered approach offers our patients the emotional support, cognitive and behavioral therapies most helpful for those who suffer with long-term chronic pain.
Make an appointment with Dr. Andrus or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.