The treatment plan for a patient with spondylosis is usually non-surgical, with conservative therapeutic strategies tried for at least six months in most cases. This can involve physical therapy, medications such as NSAIDs and analgesics, alternative therapies such as acupuncture, massage, and chiropractic treatment, and even cognitive behavioural therapy for patients whose quality of life is diminished by their condition. A recent study found that patients actually have a more pronounced reduction in pain when they believe they are getting effective pain medication, and that the efficacy of the drug lowers if they are told it is a placebo. This may have serious repercussions for how medication is prescribed in the future, but is purely academic at the time of writing.
Patients with spondylosis may also avail themselves of therapies such as yoga and pilates as these disciplines can help to improve the strength of core muscles and aid spinal stability. An unstable spine can contribute to the pain experienced with spondylosis and patients are encouraged to develop their abdominal and back muscles in order to keep hypermobility at bay. This then puts less pressure on the joints in the spine and reduces the risk of disc degeneration, the bones rubbing together, and spinal nerve or cord compression.
Back Surgery for Spondylosis
In rare circumstances a patient may require immediate surgery for spondylosis due to the presence of spinal cord compression. This may be evidenced by bowel or bladder dysfunction. Spinal stenosis with neurological dysfunction can also lead a doctor to recommend back surgery for spondylosis, as can instability in the spine (in the facet joints for example) that may lead to neurological problems. For the majority of patients, conservative treatment of spondylosis will be the recommended course of action for six months or more, with patients who respond well to the treatment continuing on this path indefinitely. The most effective pain relief medication is often difficult to find for each patient, with many trying a variety of prescribed analgesics before finding one that proves effective. Some patients may have other conditions which make nerve problems more likely with spondylosis, or have other considerations making surgery a better option in the short-term. Back surgery should, however, never be rushed into as the risks of complication are not inconsiderable.
Spondylosis surgery usually has two distinct aims; firstly to remove the compressing material that is causing the pain (such as osteophytes or calcification of a ligament), and, secondly, to fuse the spine in order to reduce hypermobility. Decompression back surgery may be all that is required in the first instance, but many forms of decompression surgery can leave the spine less rigid and more prone to degeneration from instability. Stabilization and decompression surgeries are often carried out at the same time in order to provide a patient with a more positive outcome and reduced risk of complication at a later date.
Spondylosis Treatment Risks
The risks with each surgery include general risks as with any operation, such as anaesthetic problems, blood loss, infection, and failure of the surgery to achieve its desired aim. Minimally invasive spine surgery may be appropriate for some patients and are being developed to treat the majority of causes and conditions of back pain at an impressive rate. An experienced surgeon can talk a patient through their options and explain the risks and possible benefits associated with each procedure. Patients may be advised to cease certain medications or activities prior to surgery in order to aid their chances of success. Examples may include anticoagulant drugs that may increase the risk of excessive blood loss during a procedure, and ensuring that a patient quits smoking before any back surgery, specifically ones involving fusion which are significantly less successful in smokers versus non-smokers.
Continued Reading: Decompressive Spondylosis Surgery