What Are the Treatment Modalities for Arthritis of the Back?

Introduction

The vertebrae are the small, interlocking bones of the spine collectively termed a vertebral column. Arthritis occurs due to the gradual wearing away of the cartilage discs present within the spine between the vertebrae. The pain and stiffness can sometimes even radiate to the upper and lower back.

What Are the Components of the Spine?

The entire spine comprises 24 vertebrae beginning at the skull base. The spinal cord and its nerve bundles pass through a tunnel-like structure composed of the foramina of these vertebrae relaying messages between the brain and the body. Each pair of vertebrae articulate at three joints called the intervertebral disk and two facet joints, with cartilages that cushion the ends of the bones to prevent wear and tear by everyday friction. The vertebrae are connected together by ligaments.

What Are the Non-surgical Treatment Modalities for Back Arthritis?

• Physiotherapy.

• Mindfulness and meditation.

• Diet.

• Lifestyle modifications.

• Injection-based treatments.

• Alternative treatment modalities.

Pharmacotherapy or drug-based treatment modalities:

1. Analgesics or painkillers, anti-inflammatory drugs such as Ibuprofen and Naproxen, skeletal muscle relaxants, and in extreme cases, opioid-based medications can be used for pain management. However, the adverse effects of the drugs, as mentioned before, should be considered, and prolonged use should be avoided.

2. Opioid-based medications are not used as the first line of treatment and should be considered only for a long-term line of treatment. Most opioids are addictive and do not address the underlying cause of pain, and the body may build up a tolerance over time. A thorough examination by a specialist and only if other drugs have failed to provide relief should opioid therapy be considered.

When Is Surgery Recommended?

Severe cases of back arthritis may require a surgical option to remove and reshape bone spurs, spinal fusion, or laminectomy surgeries.

What Is Spinal Fusion?

Spinal fusion is a surgical procedure where the vertebrae are permanently joined or fused into one single solid bone with no spaces between them. The vertebrae are the small, interlocking bones of the spine collectively termed a vertebral column. Bone grafts fill the naturally occurring space between the separate vertebrae, which is filled up and sealed when the bone heals.

What Are the Postoperative Complications of Spinal Fusion?

As with any major surgical procedure, spinal fusion surgery may also carry risks of certain complications, as follows;

• Infection of the surgical site.

• Blood clots in the head and neck or extremities.

• Dissemination of blood clots to the lungs may be fatal.

• Bleeding and blood loss may lead to death.

• Respiratory distress.

• Increased risk of a heart attack during an ongoing surgery.

• Increased risk of strokes.

• Delayed or inadequate wound healing due to systemic diseases such as diabetes.

• Allergic or anaphylactic reactions to medications or anesthetic agents administered.

Certain rare complications may also be seen, enlisted as follows;

• Infection in the treated vertebrae.

• Damage to a spinal or cranial nerve or nerve root leads to weakness, pain, bowel or bladder problems, or neuralgic pain.

• Stress on the bones adjacent to the surgically treated vertebrae due to loss of flexibility and increased stiffness.

• Persistent pain at the donor bone graft site if an autograft is used.

• Allergic reaction caused by synthetic bone grafts.

The most severe complications, as mentioned above, are blood clots, disseminated clots to other sites, and an infection of the surgical site, which have a high chance of occurring during the first few weeks of the postoperative recovery phase.

Removal of the hardware is necessary in case of postoperative pain or discomfort, and emergency help should be sought if one experiences any of the symptoms of a blood clot enlisted as follows;

• Sudden swelling in the calf, ankle, or foot.

• Redness or tenderness is seen either above or below the knee.

• Calf pain.

• Groin pain.

• Shortness of breath or difficulty breathing.

A patient should seek emergency help if any of the symptoms of infection are seen, enlisted as follows;

• Redness or swelling at the edges of the surgical site.

• Fluid drainage, such as blood or pus from the surgical site.

• Fever, chills, or elevated body temperature over 100 degrees Fahrenheit.

• Shaking and malaise.

What Is Laminectomy?

Laminectomy is also known as open decompression. It is a surgical procedure aimed at the treatment of central spinal stenosis. The spinal canal narrowing is also a possible indication of this procedure. The posterior part of the vertebra or lamina is removed to provide more space for the compressed spinal cord or nerve roots. When non-surgical treatments such as physiotherapy, pain medications, and epidural steroid injections fail to improve after 8 to 12 weeks, this procedure may be considered depending on several factors.

What Are the Risks of a Laminectomy Procedure?

Any surgical procedure is not free from the risk of intraoperative or postoperative complications such as;

• Bleeding from the surgical site.

• Infection of the surgical site.

• Blood clots in the legs can disseminate to the lungs.

• Injury to the spinal cord or nerve root.

• General anesthesia-related risks.

• Injury to the local nerve or blood vessels in and around the surgical site.

• Rarely the pain may either not subside or be aggravated postoperatively.

What Does Postoperative Recovery Look Like After Surgery?

A postoperative hospital stay of one to four days is typically required following laminectomy. The patient is kept under observation by the hospital staff for any complications. In addition, a physical therapist is appointed who works with the patient during the hospital stay to help with a guided rehabilitation program.

Recovery typically depends on the patient's fitness and level of activity before the surgical procedure is conducted. Physical therapy may be advised to improve presurgical activity levels to encourage better postoperative recovery. It typically takes four to six weeks until normal function is established.

Is Back Arthritis Preventable?

Back arthritis is an age-related condition. Thus there are no preventive measures as such. However, preventing repetitive strain from profession or hobbies, using self-help guides, periodic consultations with specialists after the specified age of occurrence, and physical therapies as and when necessary, could likely delay and deter the rate of degeneration and degradation.

Conclusion

Back arthritis usually occurs as a manifestation of the aging process. However, it can also result from prior injuries caused by trauma or repetitive strain. The underlying cause behind some cases of the chronic back is difficult to pinpoint. If the source of the pain is obscure or treatment is not possible, the best option is to reduce the intermittent flare-ups and pain management with non-surgical treatment modalities. When non-surgical and drug-based therapies fail, a surgical option must be sought.