When we talk of arthritis, we usually associate it with the image of an elderly, short-statured, fat woman in her 50s or 60s with painful, swollen and deformed knee joints with multiple medical problems like diabetes, thyroid problem, high uric acid or cholesterol. However, age-related degenerative osteoarthritis and other forms of arthritis like rheumatoid arthritis, ankylosing spondylitis, gouty arthritis and Reiter's syndrome involve the lower back or lumbar spine and neck or cervical spine at a much younger age compared to all other joints in the body.
Our lower back and neck are made up of a large number of complex joints stacked one over the other, much more complex in their anatomy than any other joints in the body. The intervertebral disc is one such joint, which acts as a shock absorber or a spring, with two facet joints at each level that provide strength and stability along with bending movements. There are two knee joints, two hip joints and two wrist joints. But because of an enormous number of complex joints in our spine—at least three joints at each of the six levels in our lower back and five joints at each of the eight levels in cervical spine, any given person is more likely to develop problems related to ageing in the intervertebral disc and facet joints of the spine rather than any other joint in the body.
The situation is made more complicated as the joints of the spine are closely associated with our spinal cord and its nervous system, and therefore, the problems of these joints invariably affect the various nerves coming out of our spine. As these joints age fast in middle age, the degeneration of the supporting structures of the backbone, too, start in the 30s and 40s or even earlier.
Other than the unavoidable process of ageing, common predisposing factors are faulty posture at job, especially in white-collared or desk job, as well as at home. Poorly designed workstations put a lot of stress on our back and neck. People working at odd hours and late are also more prone to develop spondylitis. A long drive to work is also harmful, as is constant use of mobile phones. A sedentary lifestyle, with lack of physical exercise and nutritious food, also affects the spine. Stress is another factor. Wearing improper contact lenses and glasses put a lot of stress on eyes as well as neck muscles. Uncontrolled diabetes, high blood pressure, uncontrolled thyroid problems, high uric acid, cholesterol, anxiety, depression, smoking and alcoholism can lead to spondylitis at a young age.
A majority of back and neck problems are avoidable by taking good care of posture at work and at home. Reading, watching television and working on laptops in sofas and beds is totally avoidable. Avoid stress, quit smoking and drinking and lead a healthy lifestyle, with good food and daily exercise.
In cervical and lumbar spondylitis, the intervertebral disc loses its soft gel content and springiness and becomes more hard and stiff, with loss of flexibility and movement. Loss of springiness leads to more stress on the facet joints, resulting in weak joints. The joints start opening up with abnormal gap formation, which is called spondylolisthesis. The bone of these abnormally loaded joints starts growing out as abnormal beaks or spikes. Called osteophytes, these bone projections cause pinching and compression of nerves. There is deposition of abnormal layers of calcium in the supporting ligaments that make them stiff and thickened, and these thickened ligaments also compress the nerves passing by. The surrounding muscles also become weak and shrink in size, with decrease in blood supply.
Majority of the symptoms of back and neck pain can be controlled by good physiotherapy, which includes ultrasonic massage, short wave and medium wave diathermy, interferential therapy, electrical stimulation of the nerves, acupressure, acupuncture, reiki and strengthening and stretching exercises. Drugs like muscle relaxants, nerve tonics, muscle tonics, antioxidants, omega-3, phytoproteins and those that replenish the gel of the disc or lubricating grease or synovial fluid of the facet joints can also help.
Those with severe back or neck pain, stiffness, leg pain, tingling or numbness, and neurogenic claudication, arising out of significant narrowing of the lumbar canal leading to nerve compression, can be treated by various non-surgical methods like epidural steroids, caudal epidural injections, selective nerve root blocks and facet joint injections. Other advanced techniques are pulsed radiofrequency ablation of intervertebral disc and facet joint disc, ozone disc nucleolysis, disc decompression using cold lasers, use of gamma knife and latest technique of coablation nucleoplasty and annuloplasty using coablator. All these procedures can be done in a bloodless and painless way, and no hospitalisation or bed rest is required. Accuracy of these procedures is ensured by use of computer navigation and robotics.
Even if a patient requires surgery, it can be performed in a minimally invasive way using endoscopes and special micro instruments, resulting in tiny incisions, few stitches, practically no bleeding, speedy recovery, early discharge from hospital and early return to work. The keyhole surgery is safe even for a 90-year-old patient. Safety and accuracy of these surgeries is also ensured by using precise navigation and robotic technology. Advanced techniques like cervical and lumbar disc replacement arthroplasty as well as dynamic stabilisation or non fusion techniques can be performed in a minimally invasive way for all age groups.
Dr Sudeep Jain is director, Spine Solutions India, New Delhi.