Neck or back pain that develops as we age may be a sign of spondylosis, a degenerative condition that affects the spine. Spondylosis is a normal, age-related condition. In fact, an estimated 90% of adults aged 60 years or older have this condition. However, most people with spondylosis are generally asymptomatic and don’t experience significant pain or other issues related to these arthritic changes.  

As we age, the joints and disks of the spine may start to wear out, which can cause pain and stiffness in the neck and back. In addition, associated bone spurs and disk herniation can potentially lead to nerve compression in the spine, which can cause symptoms of pain, numbness, or weakness in the arms or legs.  

Spondylosis affects men and women equally, but it is more common in certain individuals, including athletes, people who do heavy physical labor for a living, and smokers.  

Even though spondylosis doesn’t necessarily cause symptoms, there are safe and effective treatment options available for patients who do experience pain or neurologic changes related to this degenerative condition.

Spondylosis refers to the development of age-related arthritis that affects the spine. More specifically, it involves a number of different degenerative issues that affect the disks and joints of the spine.   

For example, over time, disks may become dehydrated, losing height as a result. Thus, they provide less cushioning and can actually “crack,” which can lead to herniations. Similarly, the cartilage in the spine’s joints can wear down, resulting in the formation of bone spurs.   

These arthritic changes can not only cause pain in the neck and back but can also lead to a narrowing of the spinal canal (also known as stenosis), which may compress nerves. Individuals with spinal stenosis may have neurologic symptoms in their extremities, such as numbness, tingling, or weakness radiating into their arms or legs. In severe cases, it can even lead to loss of bladder or bowel control.  

It is important to remember that while spondylosis is essentially ubiquitous in the older population, not every patient will experience symptoms or require treatment for this disease.

The most common cause of spondylosis is the cumulative joint stress that occurs as people age. It predisposes them to osteoarthritis, a common form of arthritis typically associated with progressive “wear and tear” on joint cartilage.  

Spondylosis may also arise as a result of previous trauma to the spine. For instance, this condition is more likely to occur among patients who:

• Have had car accidents, falls, or other spinal injuries
• Play competitive sports
• Perform strenuous physical activity at work
• Have had a previous neck or back surgery

The risk factors for spondylosis include the following:

• Age 60 or older
• Osteoarthritis affecting other joints
• Physically demanding jobs that may require heavy lifting or bending
• High-level athletics
• Neck or back injury
• Previous spine surgery
• Obesity
• Smoking
• Physical inactivity

Many with spondylosis do not have pain or other neurologic issues. However, some people may experience symptoms that either occur briefly or severely—or develop gradually over time.  

Signs and symptoms of spondylosis may include:

• Neck or back pain that worsens when coughing or sneezing
• Decreased flexibility in and range of motion of the neck or back
• “Clicking” sounds from the spine
• Pain radiating from the neck or lower back into the arms or legs, respectively
• Numbness, tingling, or weakness in the arms or legs
• Unsteady gait
• Muscle spasms
• Headaches
• Bladder or bowel dysfunction (in severe cases)

An individual can be diagnosed with spondylosis after their doctor obtains a medical history, performs a physical exam, and reviews diagnostic tests. Your doctor may also use this information to rule out other conditions, such as muscle strains, fractures, and cancer.  

When providing your medical history, it is important to share any history of spinal injuries or previous surgeries. You should also mention how physically active you are and if you play (or have played) sports.  

During the physical exam, your doctor will likely observe your walking ability and assess the range of motion of your spine to determine if you have any pain or stiffness. Palpation of the neck and back can also help identify the location of any tenderness associated with spondylosis. Your neurologic function will also be evaluated, including your sensation, strength, and reflexes. Special tests may also be performed to check for any signs of nerve impingement (from a disk herniation, for example).  

Finally, imaging studies like X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI) may also be used to identify any arthritic changes in the spine. Lab tests may also be useful for ruling out more concerning diseases, such as an infection or cancer.

Different treatments are available to treat spondylosis, depending on the type and severity of symptoms.  

Treatments for milder spondylosis include:

• Activity modification, such as avoiding activities that cause pain
• Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), over-the-counter analgesics (acetaminophen, for example), and muscle relaxants
• Hot/cold compresses, massage, and traction
• Physical therapy, such as strengthening and flexibility exercises and ergonomic education
• Spinal injections, such as an epidural around nerves and facet joints

In more severe cases, surgery might be the best course of action. It may involve the following procedures:

• Decompression (laminectomy, discectomy), which involves the removal of bone spurs, disk herniations, and arthritis to relieve compression of the nerves and address neurologic symptoms
  
• Fusion, which is the formation of bone across adjacent vertebral bodies to stabilize the spine and relieve pain

Fortunately, most individuals with spondylosis will not experience symptoms and may never even realize that they have arthritis in their spines. However, for those who experience pain or neurologic changes due to nerve compression, safe and effective treatments are available.

“Spondylosis is one of the most common spinal diseases we encounter; in my experience, most patients can be managed successfully with conservative measures,” says Yale orthopaedic surgeon Peter Whang, MD. “However, in instances where individuals continue to suffer from severe pain or develop neurologic symptoms, at Yale we have access to cutting-edge technologies and novel therapeutic interventions, including intraoperative navigation, robotic surgery, and minimally invasive procedures, so that we can treat patients in a safer and more effective manner, allowing them to recover from surgery more rapidly and resume their normal life activities.”