PAIN MANAGEMENT
Dr. Stan Golovac
Dr. Stan Golovac
Spondylosis is a general term for the degenerative disease process affecting the spine.
YOUR DOCTOR may use this term or degenerative disc disease to describe the typical age-related anatomic changes in the spine due to wear and tear. The degenerative process of spondylosis (spinal osteoarthritis) may impact the cervical (neck), thoracic (upper back), and/or lumbar regions (lower back) of the spine. This natural part of aging affects the intervertebral discs and facet joints, and it may cause pain.
It’s believed that these degenerative changes begin at the intervertebral disc; for example, a tear in the outer layer of the disc, known as the annulus. These changes then have deleterious effects on the facet joints and the ligamentous, neural, and bony relations of the spine.
Narrowing of the space between vertebrae (from disc degeneration) is an important cause of many of these interdependent degenerative changes to the lumbar spine. Progressive degenerative changes in the facet joints can lead to marked instability and both conditions can entrap nerves and eventually lead to chronic nerve damage. Advanced spondylosis can include thickening and ossification of spinal ligaments that further contribute to nerve compression.
Symptoms: The signs and symptoms of arthritis include inflammation and joint pain. In the spine, symptoms may also include general back pain, weakness, numbness, and stiffness that decreases with activity.
Symptoms of lumbar spondylosis follow those associated with each of the various aspects of the disorder: disc herniation, sciatica, spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis.
THE DEGENERATIVE process of spondylosis (spinal osteoarthritis) may impact the cervical (neck), thoracic (upper back), and/or lumbar regions (lower back) of the spine. This natural part of aging affects the intervertebral discs and facet joints, and it may cause pain.
Pain associated with disc degeneration may be felt locally in the back or in another area. This is called “referred pain” because the pain is not felt at its site of origin. Lower back arthritis may be felt as pain in the buttock, hips, groin, and thighs. Specifically, with spinal stenosis or disc herniation in the lumbar region, it’s important to be aware of any bowel or bladder incontinence, or numbness in the perianal area. These signs and symptoms could represent an important massive nerve compression needing surgical intervention.
Diagnostic tests: X-ray studies demonstrate much of the characteristic appearance of spondylosis narrowing of the intervebral disc space and the neural foramina (bony canals by which the spinal nerves exit the vertebral column). Also visible are the presence of osteoarthritis and the formation of osteophytes (small bone spurs) on areas of the vertebrae adjacent to the discs and in the area of the facet joints. Soft tissue injuries such as herniated disc and nerve root impingement are best seen with advanced imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and myelography.
Treatment: Management of the various degenerative components of spondylosis depends on the type of presentation, the age of the patient, and the degree of severity of the disease. Nonoperative treatment with or without rehabilitation may be very effective for some aspects and surgical intervention for others.
There are several ways to improve this condition. Initially, becoming involved in aqua therapy is a key way to accommodate, exercise, and begin to establish function of the arthritic spine.
Joyce Tabur, who at 72 years old has suffered from spondylosis for more than 30 years, finally found relief through radiofrequency ablation. Now Joyce comfortably enjoys her normal activities—especially feeding the fish on a sunny Florida day.
This condition can remarkably improve with a very simple procedure called a Facet or Median Branch Nerve Injection. With the use of a fluoroscope, which is an X-ray beam used to identify the joints that need to be targeted, a specialist trained in interventional pain management identifies the area, injects the target nerves involved, and renders the area pain-free. If the nerve injection is successful in establishing the correct nerve and relieving the pain, a procedure called “radiofrequency ablation (RFA)” can be performed as an outpatient. This procedure uses an electrical current produced by a radio wave to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. The procedure usually takes 15 to 20 minutes, is generally well tolerated, and has very few associated complications such as a slight risk of infection and bleeding at the insertion site.
The main side effect of RFA is some discomfort, including swelling and bruising, at the site of the treatment, but this generally goes away after a few days. After completion of the treatment, the area will usually be without pain for 12 to18 months, and in some cases relief can last for years, allowing the patient to return to a quality of life he or she once experienced.
The prognosis of spondylosis is related to the age, severity, and components of the disorder. While elimination of the disease is not likely, early and appropriate treatment can minimize or manage many symptoms effectively.
Stanley Golovac, MD is the co-director of Space Coast Pain Institutue. Dr. Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami. Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Cape Canaveral Hospital/Health First Pain Management and the Space Coast Surgery Center of Pain Management. For more information log on to YourPainInstitute.com
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